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Form 3160-5 UNITED STATES FORM APPROVED 37 (June 2015) Expires:O 2 DEPARTMENT OF THE INTERIOR MB January '31, 018 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.16H-RI 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 Boles Bed 4.Location of Well(Footage,Sec., T.,R.,M.,or Survey Description) 11.Country or Parish,State Lat:39.926848404 Long:-108.371348247 NAD 83-Sec.34,T1S,R98W 146'FNL,533.9'FEL 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(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 detennined that the site is ready for final inspection.) All depths are referenced to GL.The 16H-RI well reached the end of its useful life and has been abandoned.The 9.625"casing was cleaned with fresh water to the top of the ASI-X packer at 1939.7 feet and the 2.875"EUE tubing was flushed from 1939.7 feet to 2181.8 feet.A 9.625"casing scraper was run to a depth of 1,915 feet.The 9.625"casing was perforated at depths of 1,900, 1,775,1,650, 1,275, 1,040,440,230,and 100 feet.Each perforation interval consists of four 0.38"holes at 90 degree phasing and 20.5"of penetration. All cement plugs were set using balance method and consisted of Portland Type 1/11 cement. Plug 1 was pumped at 1,910 feet and consisted of 5.0 cu yds(105 sks)with High Early accelerant. Plug 1 was allowed 14.25 hours to set,after which the top of cement was tagged at 1,710 feet. Plug 2 was pumped at 1,680 feet and consisted of 7.0 cu yds(147 sks)with High Early accelerant. Plug 2 was allowed 5 hours of set time,before the top of cement was tagged at 1,326 feet. Plug 3 was pumped from a depth of 1,290 feet and consisted of 7.5 cu yds(157.5 sks)with High Early accelerant. Plug 3 was allowed 16.0 hours to set,prior to tagging the top of cement at 891 feet. Plug 4 was pumped at 865 feet and consisted of 7.5 cu yds(157.5 sks)with High Early accelerant. Plug 4 was allowed 5.75 hours of set time,after which the top of cement was tagged at 447 feet. Plug 5 was pumped from a depth of 440 feet and consisted of 7.5 cu yds(157.5 sks)with High Early accelerant.Plug 5 reached surface and eventually fell back to 12 feet below GL.and topped off with 0.1 cu yds(2 sks)of Portland 1/11 cement on 9/20/22. The well was dug out at the surface and the casing cut off 3 feet below GL.A plugged and abandoned hole marker was installed per the Natural Soda UIC permit.The calculated volume of the 1,939.7 feet of 9.625"casing is 31.2 cu yds(842.0 cu ft),plus the calculated volume of 2.875"tubing from 1939.7 feet to 2181.8 feet is 0.3 cu yds(7.9 cu ft).A total of 34.6 cu yds(934.2 cu ft,726.5 sks)of cement,9.9%excess,was used to plug and abandon the 16H-RI. For additional information please see attached As-Built Plug and Abandonment diagram. This work was performed under the Colorado Division of Reclamation and Mine Safety permit number M-1983-194. 14.I hereby certify that the foregoing is true and correct. Name(Printed/Typed) Gearld J.Daub Title President,Daub&Associates,Inc. Signature oy_'e'� Date aZZ �QZ 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.0 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)