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FORM APPROVED OMB <br /> Form 3160-5 <br /> UNITED STATES No. 1004-0137 Expires: <br /> (June 2019) DEPARTMENT OF THE INTERIOR December 31,2024 <br /> BUREAU OF LAND MANAGEMENT S.Lease Serial No. COC-0118327 <br /> SUNDRY NOTICES AND REPORTS ON WELLS 6.If Indian,Ailotteeor 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 WcII <br /> ❑Oil Well ❑ Gas Well m Other 8.Well Name and No.15H-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 /> 6 FSL,567 FEL,S27,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(Start/Resume) ❑Water Shut-Off <br /> ❑Alter Casing ❑Hydraulic Fracturing 0 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 ofall pertinent markers and zones.Attach <br /> the Bond under which the work will be perfonned or provide the Bond No.on file with BLM/BIA.Required subsequent reports must be filed within 30 days following <br /> completion ofthe 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 /> All depths referenced to GL.Remove all existing surface and downhole equipment from well. Run in the well with casing scraper to approximately-1,875 <br /> feet to the top of the liner hanger,pump down 90bbls of fresh water to flush and clean well. Run in the well and set a 7.0-inch cast iron bridge plug(CIBP) <br /> at approximately 1,870 feet. Run in hole with perforation gun and perforate(4 spf,90 or 120 degree phasing)7.0-inch intermediate casing. Perforation <br /> zones:1,550,1,475,500.and 325 feet. Cement to surface in stages with—92 bbls(19.1 cubic yards)of Portland 1111 cement(Based on 25%excess).For <br /> additional detail please refer to the attached Drilling and Well Completion Diagram. This activity is anticipated to occur over a period of three to four days <br /> during the second or third quarter of 2023. This work will be performed under the Colorado Division of Reclamation and Mine Safety permit number <br /> M-1983-194. <br /> 14 l hereby certify that the foregoing is true and correct. Name(Printed/Typed) <br /> Gerald J Daub Title President Daub&Associates,Inc. <br /> Signature Date ? Z IT Z 3 <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 arty 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 />