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2022-10-12_HYDROLOGY - M1983194
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2022-10-12_HYDROLOGY - M1983194
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Last modified
10/12/2022 8:40:37 PM
Creation date
10/12/2022 10:07:24 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1983194
IBM Index Class Name
Hydrology
Doc Date
10/12/2022
Doc Name
Abandonment Report
From
Daub & Associates, Inc
To
DRMS
Email Name
THM
Media Type
D
Archive
No
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FORM APPROVED <br /> Form 3160-5 <br /> UNITED STATES OMB No.1004-0137 <br /> (June 2015) DEPARTMENT OF THE INTERIOR Expires:January 31,2018 <br /> BUREAU OF LAND MANAGEMENT 5.Lease Serial No. COC-0118327 <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/Agrecment,Name and/or No. <br /> 1.Type of Well <br /> ❑Oil Well ❑ Gas Well ©Other 8.Well Name and No.DVPW-1 <br /> 2.Name of Operator Natural Soda LLC 9.API Well No. <br /> 3a.Address 3200 Rio Blanco County Rd 31 3b.Phone No.(include area code) 10.Field and Pool or Exploratory Area <br /> Rifle,CO.,81650 (970)878-3674 Piceance Creek Basin <br /> 4.Location of Well(Footage,Sec.,T.,R.,M.,or Survey Description) 11.Country or Parish,State <br /> 627.8'FSL,3159.7'FWL,Sec.26,T1S,R98W,6th P.M. 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 /> ❑Notice of Intent ❑Acidize ❑Deepen ❑Production(Start/Resume) ❑Water Shut-Off <br /> ❑Alter Casing ❑Hydraulic Fracturing ❑Reclamation ❑Well Integrity <br /> ©Subsequent Report ❑Casing Repair ❑New Construction ❑Recompletc ❑Other <br /> ❑Change Plans Q✓ 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.Attach <br /> the Bond under which the work will be performed or provide the Bond No.on file with BLMBIA.Required subsequent reports must be filed within 30 days following <br /> 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 <br /> completed.Final Abandonment Notices must be filed only after all requirements,including reclamation,have been completed and the operator has detennined that the site <br /> is ready for final inspection.) <br /> See attached Completed Operation description: <br /> 14.I hereby certify that the foregoing is true and correct. Name(Printed/Typed) <br /> Gearid J.Daub Title President,Daub&Associates, Inc. <br /> Signature — Date �� <br /> THE SPACE FOR FEDERAL OR STATE OFICE USE <br /> Approved by <br /> Title Date <br /> ------------------------------------------------------------------------ <br /> Conditions of approval,if any,are attached.Approval of this notice does not warrant or <br /> certify that the applicant holds legal or equitable title to those rights in the subject lease Office <br /> which would entitle the applicant to conduct operations thereon. <br /> 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 <br /> any false,fictitious or fraudulent statements or representations as to any matter within its jurisdiction. <br /> (Instructions on page 2) <br />
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