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<br />Form 3160-5 UNITED STATES <br />(September 2001) DEPARTMENT OF THE INTERIOR <br />BUREAU OF LAND MANAGEMENT <br />SUNDRY NOTICES AND REPORTS ON WELLS <br />Do not use this form for proposals to drill or to re-enter an abandoned well. <br />Use Form 3160 - 3 (APD) /or such proposals. <br />SUBMIT IN TRIPLICATE-Other instructions on reverse side. <br />Oil We11 Gas Well <br />2. Name of Operator <br />Other X Sodium Bicarbonate <br />Solution mining well <br />FORM APPROVED OM B No. 1004-0135 <br />Expires: January 31, 2004 <br />S. Lease Serial No. <br />Sodium lease C- <br />0118327 <br />6. If Indian, Allottee or Tribe Name <br />EPA permit CO 30358-00000 <br />7. If Unit or CA/Agreement, Name <br />and/or No. <br />Natural Soda, Inc. <br />8. Well Name and No. <br />4A-2V <br />Address 36. Phone No. (include area <br />3a. 3200 County Road 31, Rifle Colorado 81650 code) 970-878-3674 <br />Location of Well (Footage, Sec., T., R., M., or Survey Description) <br />1458 FSL, 1167 FWL, SEC 26, T1S, R98W <br />TYPE OF SUBMISSION ~ TYPE OF ACTION <br />^ Notice of Intent <br />® Subsequent Report <br />^ Final Abandonment <br />Notice <br />10. Field and Pool, or Exploratory <br />Area <br />Boles-Bed /saline zone <br />11. County or Parish, State <br />Rio Blanco .Colorado <br />^ Acidize ^ Deepen ^Production ^Water Shut-Off <br />^ Alter Casing ^ Fracture Treat (Stazt/Resume) ^Well Integrity <br />^ Casing Repair ^ New Construction ^Reclamation ^Other <br />^ Change Plans ®Plug and Abandon ^Re-complete <br />^ Convert to ^Temporarily Abandon <br />Injection ^Water Disposal <br />l3. Describe Proposed or Completed Operation (clearly state all pertinent details, including estimated starting date of any proposed work and approximate <br />duration thereof. If the proposal is to deepen directionally or re-complete horizontally, give subsurface locations and measured and true vertical depths of all <br />pertinent markers and zones. Attach the Bond under which the work will be performed or provide the Bond No. on file with BLM/BIA. Required subsequent <br />reports shall be Fled within 30 days following completion of the involved operations If the operation results in a multiple completion or re-completion in a new <br />interval, a Form 3160-4 shall be filed once testing has been completed. Final Abandonment Notices shall be filed only after all requirements, including <br />reclamation, have been completed, and the operator has determined that the site is ready for final inspection.) <br />Rig up work over rig on well. Flush casing with hot water. Pull 7 in. production string. Set CIBP (cast iron bridge plug) @ 1920 feet. Fill well with water. Run <br />cement bond log. to verify cement behind casing. Goad cement from bottom of well up to 800 ft. Ratty cement from 800 ft to surface, but cement is shown above <br />Perched aquifer. Run tubing to f 890 ft. Pump 190 sacks of class G 15.8 cement in well. Pull tubing 18 joints. Wait on cement. Tag cement top @ 1365 fl. Pump <br />335 sacks 12.8# light cement to surface. Pull tubing from well. Cement annulus from surface down until full. Install dry hole marker on well. Reclaim location as <br />per BLM requirements. <br />14. I hereby certify [hat the foregoing is true and correct <br />Name (Printed/Typed): Rodnev A. Storev Title: WELL FIELD <br />Signature: <br />28 June <br />THIS SPACE FOR FEDERAL OR STATE OFFICE USE <br />Approved by: <br />Title: <br />Office: <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 <br />which would entitle the applicant to conduct operations thereon. <br /> <br /> <br /> <br /> <br /> <br />Signature of Cementer or Authorized Representative Signature of EPA Representative <br />CE TIFICA ION <br />I certify under penalty of law that this document and all attachments were prepared under my direction or <br />supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate <br />the information submitted. Based on my inquiry of the person or persons who manage the system, or those <br />persons directly responsible for gathering the information, the information submitted is, to the best of my <br />knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting <br />false information, includin the ossibilit of fine and im risonment for knowin violation. (Re . 40 CFR 122.22). <br />.Name and Official Title (please type or print) Signature <br />~ ~ O Date Signed <br />28 June 29, 2005 <br />