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Form 3160-5 UNITED STATES FORM APPROVED (August 2007) OMB No. 10040137 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 CAJAgreement,Name and/or No. 1.Type of Well El Oil Well El Gas Well m Other BD.VPWll 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 32M Rio Blanco County Road 31 Piceance Creek Basin Rifle.CO 81650 (970)878-3674 4. Location of Well(Footage,Sec., T.,R..Al.or Survev Description) 11.Country or Parish,State 627 8'FSL.3159 7'FWL.Sec M T1S.R98W) 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 ©Notice of Intent ❑Acidize ❑Deepen ❑ Production(Siart/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 a new 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 surface and downhole equipment from well.Pull the 4.54nch production and injection tubing string from the south well.Run in the south 7.0-inch casing string with a casing scraper to 2,344 feet,condition and clean hole.Set a cast iron bridge plug at 2,334 feet. Run in the south hole open ended to 2,330 feet and pump 92 bbls(19.1 cubic yards)of cement to surface in batches. Pull the 4.5-inch production and Injection tubing string from the nouth well.Run in the north hole with a casing scraper to 2,344 feet,circulate and dean well. Set a cast iron bridge plug at 2,334 feet.Run in hole with a perforation gun and perforate(4 spf,90 or 120 degree phasing)4.5-inch intermediate casing. Perforation zones:2,235,2,125,2,030,1,845,335,200,and 75 feet. Cement to surface in stages with—115 bbls(23.9 cubic yards)of Portland 1/II cement. For additional detail please refer to the attached Drilling and Well Completion Diagram. This activity is anticipated to occur over a period of five to six days during May 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/Tvped) Gerald J.Daub ride President,Daub&Associates,Inc. Signature Date 2 0 L Z THIS SPACE FOR FEDERAL OR TATE OFFICE USE Approved by Title Date Conditions of approN al,if any,are attached. A-ppir-o-va,f of this notice does not warrant or 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 a illfully to make to any department or agency of the United States any false, fictitious or fraudulent statements or representations as to any matter within its jurisdiction (instructions on page 2)