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Page 2 of 3 <br /> SUd l/4 of the IS 1,/$of Section i a To��✓nship I��N Range L �v <br /> 10th Principal Meridian Montrose County <br /> If the area has not been surveyed, supply the Longitude 08.7475195 West and Latitude 38.2350232 North, <br /> or attach a location map,preferably a USGS Quad. <br /> The following additional information is required for artesian flowing holes: <br /> Feet ❑ North ❑ South from the ❑ South ❑ North section line <br /> feet ❑ east !—! West from the I I 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 1 or subsection 2 boxes as appropriate and provide the <br /> requested information) <br /> 1. Plugged dry hole, method of plugging: 3/8"Baroid 201102 Bentonite chip to l'below surface,clean fill to surface <br /> Depth at which concrete plug set: rt�a feet below ground surface. <br /> © 2. Sealed Hole(when groundwater is encountered): <br /> 0 2a.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 /> ET2c. Abandonment Fluid Mixture(Such as Sodium Bentonite with Polymer)Brand Name: <br /> Marsh Funnel viscosity of abandonment fluid: sec. <br />