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Form 3160.5 UNITED STATES PoaM nrraoven <br />Qune 1990) DEPARTMENT OF THE INTERIOR anger s,ve.,, Na tooa-ox39 <br /> Ex ves Much 31, 1993 <br />BUREAU OF LAND MANAGEMENT s. Leese oe~etwn..,d send Ns <br /> Yanks Gulch C4118328 <br />SUNDRY NOTICES AND REPORTS ON WELLS <br />Do not use this form for proposals to drill or to deepen or reentry to a different reservoir. b ur.,a~..~, Amami orinbe N~ <br />Use "APPLICATION FOR PERMIT-" for such N/A <br />SUBMIT QJ TRIPLICATE r. u u~w orCA, ng.o~.r ~+gna~os <br /> A <br />1. Type of Well awes Neme.m Na <br />^ Oil Well ^ Gas WeB ®Other Nahcolite Solution Minim American Soda LLP 28-21 <br />2 Name of Operator 9. npt well No. <br />American Soda, LLP. <br />3. Address and Telephone No. ro. Pield ud Pod, orEapb,em.y ~^ <br />2717 C . Rd. 215 Pazachute, CO 81635 970 2&SbSW Central Piceance Creek Basin <br />4. Location of Well (Footage, Sec., T., R, M., or Survey Description) tt. r o.ey or Ped.n,s~me <br />E 15,21214 N 72,376.71 NW ~/~ of NW'A of Section 28, 715, R97W CW P.M. Rio Blancq CO <br />12 CHECK APPROPRIATE BOX(s) TO INDICATE NATURE OF NOTICE, REPORT OR OTHER DATA <br />TYPE OF SUBML%ION TYPE OF ACTION <br />^ Notice of Intent ^ Abandonment ^ Change of Plans <br /> ^ Remmpletion ^ New Constmction <br />®Subsequem Reports ^ Plugging Back ^ NmrRoutine Fracturing <br /> ^ Casing Repau ^ Water ShubO&' <br />^ Fina] Abandonment Nodre ^ Altering Casing ^ Converson to htjedion <br /> X Other: Long Term Standby O Disport. Water <br /> Wax expat~mao.axpe.~pma,eowm <br />n oxoa<»wmma~ P~d~~i~l~mPea tAamr. od girepvaeuta,b adWegemaed AhdmadogmrPmP~~ak ll~m'v avenmmyamm. <br />mammvrzamdweva~~ a~pm(msumWa+mdrmnpesemmmu ratY <br />This well is scheduled for long term standby. U emnomits improve, this weB could be brought back into production. <br />WeB 28-21 dissolution surface at 1460'. <br />7/20/2004 Rig up Key Energy on well. <br />7/21/04 Pull 2172' (all) of 4 yx" long string. Set tart iron bridge plug on T' long casing at 1615'. PuB 1758' (all) of 4 rh" short string. Set test <br />icon bridge plug at 1615' on T' short string. Rig down Key Energy. <br />14. I hereby certify [fiat the foregoing is tme and mrreR. <br />Signed <br />(74ris spare for Federal or State office use) <br />Approved by <br />Conditions of approval, if any: <br />Ti0e IS US.C. Section 1001, makes it a crime for any persmr knowingly and willfully to make to any department or agency of the United <br />Slates any false, fictitious or fraudulent statements or representations as to any matter within its juri9dictian. <br />'See Instruction on Reverse Side <br />