2022-05-10_GENERAL DOCUMENTS - M1983194

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Form 3160-5 UNITED STATES FORM APPROVED (June 2015) OMB J n 1004-0137 Expires. DEPARTMENT OF THE INTERIOR January 31,2018 BUREAU OF LAND MANAGEMENT 5.Lease Serial No. COC-0118327 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/Agreement,Name and/or No 1.Type of Well ❑Oil Well ❑ Gas Well ©Other 8.Well Name and No.12H-IR 2.Name of Operator Natural Soda LLC 9 API Well No 3a.Address 3200 Rio Blanco County Rd 31 3b.Phone No.(include area code) 10 Field and Pool or Exploratory Area Rifle,CO.,81650 (970)878-3674 Boies Bed 4 Location of Well(Footage,Sec.,T.,R.,M.,or Survey Description) 11 Country or Parish,State 879.4 FSL,1393 4 FWL,S26,T1S,R98W,6th PM Rio Blanco 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(Start/Resume) ❑Water Shut-Off ❑Alter Casing ❑Hydraulic Fracturing ❑Reclamation ❑Well Integrity ❑Subsequent Report ❑Casing Repair ❑New Construction ❑Recomplete ❑Other ❑Change Plans ❑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 3160-4 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) All depths referenced to ground level(GL).A cast iron bridge plug(CIBP)will be set in the 7-inch production liner at a depth of 2650 feet.The 7-inch production liner will then perforated from approximately 2567 to 2600 feet(33 feet).While cleaning out the well,a bit assembly and two joints of drill pipe were left inside the liner at approximately 2900 feet MD GL,thus necessitating this pull-back.(See attached 12H-IR Well Completion Diagram) 14.I hereby certify that the foregoing is true and correct. Name(Printed/Typed) Gerald J.Daub Title President/Daub&Associates,Inc. Signature Date ¢ Z O L Z THE SPACE FOR FEDERAL OR STATE OFICE USE Approved by Title Date ------------------------------------------------------------------------ Conditions of approval,if any,are attached.Approval of this notice does not warrant or certify that the applicant holds legal or equitable title to those rights in the subject lease Office which would entitle the applicant to conduct operations thereon Title 18 U S C Section 1001 and Title 43 U S.0 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 within its jurisdiction. (Instructions on page 2)