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Page 2 of 3 <br /> S'v1f 1!4 of the L E 1!4 of Section i Township E46N Range 'iL iW <br /> r10th Principal Meridian Montrose County <br /> If the area has not been surveyed, supply the Longitude 108.7471325 West and Latitude 38.2345990 North, <br /> or attach a location map,preferably a USGS Quad. <br /> The following additional information is required for artesian flowing holes: <br /> Feet s North ❑ South from the ❑ South ❑ North section line <br /> feet ❑ east s West from the L_! west !� East section line <br /> NOTE: In the case of closely spaced drill holes having similar geologic and hydrologic characteristics,the Operator may, <br /> with the approval of the Division,submit a single consolidated final report including the location of all drill holes and a <br /> description of abandonment technique. In such case,complete one abandonment final report form and attach a list of drill <br /> hole locations. If more space is needed to provide any of the information for this form,please attach separate sheets. <br /> IV. Complete Either Subsection A or B: <br /> PERMANENT ABANDONMENT (Check either box I or subsection 2 boxes as appropriate and provide the <br /> requested information) <br /> 0 1. Plugged dry hole, method of plugging: 3/8"Baroid 201102 Bentonite chip to 1'below surface,clean fill to surface <br /> Depth at which concrete plug set: n�a feet below ground surface. <br /> 7 2. Sealed Hole(when groundwater is encountered): <br /> n2a.Neat Cement Grout, top to bottom: grout mixture used: <br /> Intervals grouted(feet beneath ground surface, method and materials): <br /> 2b,Neat Cement Grout, interval grouting, grout mixture used: <br /> Intervals grouted(feet beneath ground surface, method and materials): <br /> 2c. Abandonment Fluid Mixture(Such as Sodium Bentonite with Polymer)Brand Name: <br /> Marsh Funnel viscosity of abandonment fluid: sec. <br /> i <br />