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Form 3160-5 UNITED STATES FORM APPROVED <br /> (August 20071 OMB No.1004-0137 <br /> DEPARTMENT OF THE INTERIOR Expires:July 31,2010 _ <br /> BUREAU OF LAND MANAGEMENT 5.Lease Serial No. <br /> C-0119986 <br /> SUNDRY NOTICES AND REPORTS ON WELLS 6.If Indian,Allottee or Tribe Name <br /> Do not use this form for proposals to drill or to re-enter an <br /> abandoned well. Use Form 3160-3(APD)for such proposals. <br /> SUBMIT IN TRIPLICATE—Other instructions on page 2. 7.If Unit of CA/Agreement,Name and/or No. <br /> 1.Type of Well <br /> ❑Oil Well El Gas Well m Other 8B.G;II Name and No. <br /> 2.Name of Operator 9.API Well No. <br /> Natural Soda LLC <br /> 3a,Address 3b, Phone No.(include area code) 10.Field and Pool or Exploratory Area <br /> 32M Rio ftrw County Road 31 Piceance Creek Basin <br /> Rifle,CO 91650 (970)878-3674 <br /> 4. Location of Well(Footage,Sec.. T..R.,M..or Survev Description) 11.Country or Parish.State <br /> 382.3'FNL.7482'FWL.sec 35.71S,R98W) Rio Blanco County,Colorado <br /> 12. CHECK THE APPROPRIATE BOX(ES)TO INDICATE NATURE OF NOTICE,REPORT OR OTHER DATA <br /> TYPE OF SUBMISSION TYPE OF ACTION <br /> mNotice of Intent ❑Acidize ❑Deepen ❑ Production(Start/Resume) ❑ Water Shut-Off <br /> ❑Alter Casing ❑Fracture Treat ❑ Reclamation ❑ Well Integrity <br /> ❑Subsequent Report ❑Casing Repair ❑New Construction ❑ Recomplete ❑Other <br /> ❑Change Plans m Plug and Abandon ❑Temporarily Abandon <br /> ❑Final Abandonment Notice ❑Convert to Injection ❑Plug Back ❑ Water Disposal <br /> 13.Describe Proposed or Completed Operation:Clearly state all pertinent details,including estimated starting date of any proposed work and approximate duration thereof If <br /> the proposal is to deepen directionally or recomplete horizontally,give subsurface locations and measured and true vertical depths of all pertinent markers and zones. <br /> Attach the Bond under which the work will be performed or provide the Bond No.on file with BLM/B1A. Required subsequent reports must be filed within 30 days <br /> following completion of the involved operations. If the operation results in a multiple completion or recompletion in anew interval,a Form 3160-4 must be filed once <br /> testing has been completed. Final Abandonment Notices must be filed only after all requirements,including reclamation,have been completed and the operator has <br /> determined that the site is ready for final inspection.) <br /> Remove all existing monitoring equipment from well. Run cement bond log to determine annular cement interval. Run in the well to approximately—1559', <br /> drill outcast iron bridge plug. Continue tripping Into circulate and clean the hole out to a depth of 1703'(reported top of cement plug in casing)and drill to <br /> —1713'. If cement is competent,circulate and condition well bore for cementing,if cement is ratty,drill out to 1832'. Run in hole with perforation gun and <br /> perforate 4.5-inch intermediate casing. Adjust final perforation zones based on CBL(4 spf,90 or 120 degree phasing). Preliminary perforation zones:1,250, <br /> 1,100,1,000,500,250&50 feet. Cement to surface in stages with—32.1 bbls(6.7 cubic yards)of Portland l/ll cement.For additional detail please refer to the <br /> 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 <br /> 2022. This work will be performed under the Colorado Division of Reclamation and Mine Safety permit number M-1983-194. <br /> 14. 1 hereby certify that the foregoing is true and correct. <br /> Name(Printed/T)ped) <br /> Gerald J.Daub Title President,Daub&Associates,Inc. <br /> Signature Date 7 ZCL Z <br /> THIS SPACE FOR FEDERAL OR STATE OFFICE USE <br /> Approved by <br /> Title Date <br /> Conditions of approval,if any,are attached. Approval of this notice does not warrant or certify <br /> that the applicant holds legal or equitable title to those rights in the subject lease which would Office <br /> entitle the applicant to conduct operations thereon. <br /> Title 18 U.S.C.Section 1001 and Title 43 U.S.C.Section 1212.make it a crime for any person know ingly and willfully to make to any department or agency of the United States any false, <br /> fictitious or fraudulent statements or representations as to any matter within its jurisdiction <br /> (Instructions on page 2) <br />