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Form 3160-5 UNITED STATES FORM APPROVED OMB <br /> (June 2019) No. 1004-0137 Expires- <br /> DEPARTMENT OF THE INTERIOR December 31,2024 <br /> BUREAU OF LAND MANAGEMENT 5.Lease Serial No. COC-0119985 <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 ❑ Gas Well ©Other &Well Name and No.RS-96-20-1 <br /> 2.Name of Operator Natural Soda LLC 9.API Well No. <br /> 3a.Address 3200 Rio Blanco County Rd 31 rb Phone Nn.(include area code) 10.Field and Pool or Exploratory Area <br /> Rifle,CO.81650 0)878-3674 Piceance Creek Basin <br /> 4.Location of Well(Footage,Sec., T.,R.,M.,or Survey Description) I I.Country or Parish,State <br /> 2418.3 FNL,2134.6 FEL,S20,T1 S.R98W,6th PM Rio Blanco County,CO <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(StartlResume) ❑Water Shut-Off <br /> ❑Alter Casing ❑Hydraulic Fracturing ❑Reclamation ❑Well Integrity <br /> ❑Subsequent Report ❑Casing Repair ❑New Construction ❑Recomplete ❑Other <br /> ❑Change Plans ©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 BLM/BIA.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 determined that the site <br /> is ready for final inspection.) <br /> All depths referenced to GL.Remove all existing surface and downhole equipment from well. Run in hole with 3.875-inch bit to approximately 1,261 feet <br /> and drill out cement to the top of the open Role packer at 1,295 feet,drill though the packer,attempt to re-enter cut 4.5-inch casing at 1,350 feet. If casing <br /> may be reentered,continue to 1,717 feet and circulate and condition hole. Run in the hole with a perforation gun and perforate the 4.5-Inch casing(4 <br /> holes pf at 90-120 degree phasing)at depths of 1,700, 1,640, 1,550,1,450,460,265,and 75 feet.Mix and pump 41.6 bbls(8.65 cubic yards)of Portland <br /> Type I111 cement down hole in stages(Based on 10%excess). Top off as necessary,cut off casing 3-5 feet below surface,reclaim pad. <br /> 14.1 hereby certify that the foregoing is true and correct. Name(Printed/Typed) <br /> Gerald J Daub Title President Daub&Associates,Inc. <br /> Signature Date 7 2 O 2 3 <br /> THE SPACE FOR FEDERAL OR STAf E 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 />