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Form 3160-5 UNITED STATES FORM APPROVED 37 (June 2015) E OMB No.January 1,12019 DEPARTMENT OF THE INTERIOR p BUREAU OF LAND MANAGEMENT 5.Lease Serial No. 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 or?page 2 7.IFUnit of CA/Agreement,Name and/or No. 1.Type of Well 8.Well Name and No. ❑Oil Welt ❑ Gas Well ©Other 15H-I 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 Boies Bed 4.Location of Well(Footage,Sec., T.R.,M,or Survey Description) 11.Country or Parish,State Lat:39.927254000 Long:-108.371481000 NAD 83-Sec.27,T1S,R98W 6'FSL,567'FEL Rio Bianco County,Colorado 12.CHECK THE APPROPRIATE BOX(ES)TO INDICATE NATURE OF NOTICE,REPORT OR OTHER DATA TYPE OF SUI3MISSION 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 Q 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 BLMIBIA.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 determined that the site is ready for final inspection.) All depths are referenced to GL.The 15H-1 well reached the end of its useful life and has been abandoned.The 7.0"casing was flushed with fresh water and cleaned with a 7.0"casing scraper to the top of the 4.5"liner hanger at 1875 feet.A cast iron bridge plug was set at 1872 feet.The 7.0"casing was perforated at depths of 1,550, 1,475,500,and 325 feet.Each perforation interval consists of four 0.43'holes at 90 degree phasing and 21.5"of penetration. All cement plugs were set using balance method and consisted of 14.2 lb/gal Portland Type I/il cement. Plug 1 was pumped at 1,855 feet and consisted of 6.6 cu yds(31.7 bbls, 136.5 sks)with High Early accelerant. Plug 1 was allowed 17.75 hours to set,after which the top of cement was tagged at 1,129 feet. Plug 2 was pumped at 1,075 feet and consisted of 7.0 cu yds(33,66 bbls,147 sks)with High Early accelerant. Plug 2 was allowed 6.5 hours of set time,before the top of cement was tagged at 326 feet. Plug 3 was pumped from a depth of 290 feet and consisted of 2.5 cu yds(12 bbls, 52.5 sks)with High Early accelerant.Cement from Plug 3 reached the surface at the end of pumping and eventually feel back to 73 feet.The 7.0"casing was topped of to surface with 0.6 cu yds(2.88 bbls, 12.6 sks)of Portland 1/II cement on 8/18/23. 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 1,872 feet of 7.0" casing is 15.33 cu yds(73.7 bbls,413.9 cu ft).A total of 16.7 cu yds(450.9 cu It,348.6 sks)of cement,8.2%excess,was used to plug and abandon the 151-1-1.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, 14,1 hereby certify that the foregoing is true and correct. Name(Printed/Typed) Gearld J.Daub Title President,Daub&Associates, Inc. Signature bate /0 2 j 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 wilINtly 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)