Form 3160-5 FORM APPROVED
<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.
<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 7.1f Unit of CA/Agreement,Name and/or No.
<br /> I.Type of Well
<br /> ❑Oil Well ❑ Gas Welt ❑Other 8.Well Name and No.17H-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 Boies Bed
<br /> 4.Location of Well(Footage,Sec., T.,R.,M.,or Survey Description) 11.Country or Parish,State
<br /> Lat:39.925780162 Long:-108.370924949 NAD 83-Sec.34,T1 S,R98W 541'FSL,420.3'FEL Rio Bianco 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 ❑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 perfonned 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 31604 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 are referenced to GL,The 171-1-1 well reached the end of its useful life and has been abandoned.The 7.0"casing was flushed with fresh water
<br /> and cleaned with a 7.0"casing scraper to 1868 feet.A cast iron bridge plug was set at 1862 feet.The 7.0"casing was perforated at depths of 1,407,
<br /> 1,357, 1,187,900,735,and 300 feet. Each perforation interval consists of four 0.43"holes at 90 degree phasing and 21.5"of penetration. All cement
<br /> plugs were set using balance method and consisted of 14.2 lb/gal Portland Type 1/11 cement. Plug 1 cement consisted of 6.0 cu yds(28.9 bbis, 126 sks)
<br /> with High Early accelerant and was pumped in two lifts:20.2 bbis at a depth of 1,855 feet,and 8.7 bbis at 1,528 feet.Plug 1 was allowed 6.25 hours to set,
<br /> after which the top of cement was tagged at 1,180 feet.Plug 2 consisted of 7.5 cu yds(157.5 sks)with High Early accelerant and was pumped in two lifts:
<br /> 23.8 bbis at a depth of 1,170 feet,and 12.2 bbis at 780 feet. Plug 2 was allowed 15.0 hours of set time,before the top of cement was tagged at 254 feet.
<br /> Plug 3 was pumped from a depth of 240 feet and consisted of 2.0 cu yds(10,bbls,42 sks)with High Early accelerant.Cement from Plug 3 reached the
<br /> surface. 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
<br /> Soda UIC permit.The calculated volume of the 1,862 feet of 7.0"casing is 15.24 cu yds(73.3 bbis,411.55 cu ft).A total of 15.5 cu yds(418.5 cu ft,325.5
<br /> sks)of cement, 1.7%excess,was used to plug and abandon the 17H-I.For additional information please see attached As-Built Plug and Abandonment
<br /> diagram.
<br /> This work was performed under the Colorado Division of Reclamation and Mine Safety permit number M-1983-194.
<br /> 14.1 hereby certify that the foregoing is true and correct. Name(Printed/Typed)
<br /> Gearld J.Daub Titre President,Daub&Associates, Inc.
<br /> Signature + Date �� J 2- 3
<br /> THE SPACE FOR FEDERAL OR STATE OFTCE USE
<br /> Approved by
<br /> Datc Title
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<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 Otf'ice
<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)
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