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Form 3160-5 UNITED STATES FORM APPROVED (August 2007) OMB No.1004-0137 DEPARTMENT OF THE INTERIOR Expires:July 31,2010 BUREAU OF LAND MANAGEMENT 5.Lease Serial No. C-0119986 SUNDRY NOTICES AND REPORTS ON WELLS 6-If Indian,Allottee or Tribe Name Do not use this form for proposals to drill or to re-enter an abandoned well. Use Form 3160-3(APD)for such proposals. SUBMIT IN TRIPLICATE—Other instructions on page 2. 7.if Unit of CA/Agreernent,Name and/or No. 1.Type of Well ❑Oil Well ❑Gas Well m Other 90e11 Name and No. 2.Name of operator 9.API Well No. Natural Soda LLC 3a.Address 3b. Phone No.(include area code) 10.Field and Pool or Exploratory Area 3M Rio Blanco County Road 31 Piceance Creek Basin RNIe.Co 81650 (970)878-3674 4. Location of Well(Footae,Sec., T.R..M..or Surt,ev Description) 11.Country or Parish.State 15W FSL,18W FWL,Sec.26.-AS.R88W) Rio Blanco County,Colorado 12. CHECK THE APPROPRIATE BOX(ES)TO INDICATE NATURE OF NOTICE,REPORT OR OTHER DATA TYPE OF SUBMISSION TYPE OF ACTION mNotice of Intent ❑Acidize ❑Deepen ❑ Production(Start/Resume) ❑ Water Shut-Off ❑Alter Casing ❑Fracture Treat ❑ Reclamation ❑ Well Integrity Subsequent Report ❑Casing Repair ❑New Construction ❑ Recomplete ❑ Other ❑Change Plans m Plug and Abandon ❑ Temporarily Abandon ❑Final Abandonment Notice ❑Convert to Injection ❑Plug Back ❑ Water Disposal 13 Describe Proposed or Completed Operation:Clearly state all pertinent details,including estimated starting date of any proposed work and approximate duration thereof If the proposal is to deepen directionally or recomplete horizontally,give subsurface locations and measured and true vertical depths of all pertinent markers and zones. Attach the Bond under which the work will be performed or provide the Bond No.on file with BLM/BIA. Required subsequent reports must be filed within 30 days following completion of the involved operations. If the operation results in a multiple completion or recompletion in anew interval,a Form 31604 must be filed once testing has been completed. Final Abandonment Notices must be filed only after all requirements,including reclamation,have been completed and the operator has determined that the site is ready for final inspection.) Remove all existing monitoring equipment from well. Run in the well to approximately—1368',drill out cast iron bridge plug. Continue tripping in to wash and dean the hole out to a depth of 1408'(reported top of cement plug in casing).Run in hole with perforation gun and perforate(4 spf,90 or 120 degree phasing) 4.5-inch intermediate casing. Preliminary perforation zones:500,240&50 feet. Cement to surface in stages with—25.8 bbls(5.4 cubic yards)of Portland 1111 cement.For additional detail please refer to the attached Drilling and Well Completion Diagram. This activity is anticipated to occur over a period of three to four days during the second or third quarter of 2022. This work will be performed under the Colorado Division of Reclamation and Mine Safety permit number M-1983-194. 14. 1 hereby certify that the foregoing is true and correct. Name(Printed/Tiped) Gerald J.Daub Title President,Daub&Associates,Inc. Signature Date THIS SPACE FOR FEDERAL OA STATE OFFICE USE Approved by Title Date Conditions of approval,d any,arc attached. Approval of this notice does not warrantor certify that the applicant holds legal or equitable title to those rights in the subject lease which would Office entitle the applicant to conduct operations thereon. Title 18 U.S C.Section 1001 and Title 43 U.S.C.Section 1212,make it a crime for any person knowingly and willfully to make to any department or agency of the United States any false, fictitious or fraudulent statements or representations as to any matter w ithin its jurisdiction. (Instructions on page 2)