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Page 3 of 3 <br /> Type of surface plugging used: none <br /> Depth at which plug set: one feet below ground surface, <br /> Method: n o <br /> Zd.Other method used with approval of the Division of Reclamation,Mining and Safety;describe in detail <br /> method and materials used on a separate attached sheet. <br /> B. CONVERSION TO A WATER WELL <br /> State Engineer's Permit No.: no (attach copy of permit) <br /> County Where Well is Located: no <br /> Water Well Use: no <br /> V. METHOD OF RECLAIMING DRILL SITE SURFACE DISTURBANCE: <br /> ole cuttings were removed for sampling so no significant distubance outside the 4" holes of <br /> The Operator who conducted the prospecting drill operation states that the information set forth <br /> hereupon is true to the best of their knowledge. <br /> Bryan ds Manager <br /> e f Operator's Representative) (Title) <br /> ( 'gnature of Operator's Representative) ate) <br />