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Form 3160.5 UNITID STATES FORM APPROVED <br />(June 1990) DEPARTMENT OF THE INTERIOR ~~~ 4ferNchw3t t~~ <br />BUREAU OF LAND MANAGEMENT s. e... oe.,~.rmne~dsm;d Nw <br /> Yankee Gulch CO-118328 <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. o tr tmt.n Atbllre o<Tribe Naar <br />Use "APPLICATION FOR PERMIT--" for such ro N/A <br />SUBMIT IN TRIPLICATE T. a Uart or G1, Agremiem ~igammn <br /> NA <br />_ <br />1. Type of Well a WeL Nerve and Nw <br />~ Oil Well ^ Gas Well ®Other Nahcolite Solution Minim American Soda LLP 20.30 <br />2. Name Of Operator 9. API Well Nn <br />American Soda, LLP. <br />3. Address and Telephone No. to Fleld end Pmt ar Eapbramry Are. <br />2717 C . Rd. Z15 Parachute, CO 81636 970 285-G500 Central Prance Creek Basin <br />~! Location of Web (Footage, Sec., T., R, M., or Survey Desorption) 11. County or Panab.5tate <br />B 12,756.92 N 13,275.64 SWr1i of SLn/i of Section 20, T[S, R97W 6~ P.M. Rio Blan<o, CO <br />^ Notice of Intent ^ Abandonment ^ Qwrge of Plans <br /> ^ Recompletian ^ New Construction <br />®Subsequent Reports ^ Plugging Back ^tion-Routine Fracturing <br /> ^ Casing Repair ^ Water Shut-0ff <br />^ Final Abandonment Notice ^ Altering Casing ^ Conversion to Injection <br /> X Other. Long Term Standby ^ Dispose Water <br /> INme RePaartmib iamvlXpleamvpleU®m Well <br />13. Dmvlbe Pmpm[d orCamplaeaOpmaemlMar mmaupwom~demte.ma®„epevomta.iai:lmtla6 mmreed aarM ~msml popmm want wren vevemoesy aoaal, pee rbmare lu~amm <br />..a..e..ama a.e..na eyrram.a,m~>m p.newmw:.aa.Y <br />This well is scheduled for long term standby. 0 economics improve, [his well could be brought track mto production. <br />We1120-30 dissolution surface at ]G06'. <br />8/28/2004 Rig up Key Energy on well. Pull 2431' (all) of 4 yz' long string. Set cast iron bridge plug in T' long string easing at 1660'. <br />8/30/2004 Pull 2013' (all) of 4 yz" short strhtg. Set cast uon bridge plug in T' short string at 1660'. Rig down Key Energy. <br />14. I Ireseby certify that the foregoing is true and correM. <br />Signed <br />(This space for Federal or S[a[e office use) <br />Approved by <br />Conditions of approval, if any: <br />Title 18 US.C. Section 1001, makes it a amts for any person laowingJy and willfully to make to any department or agency of the United <br />States any false, fictitious or fraudulent statements or repmsentations a9 to any matter within its jutisdictton. <br />'See Instruction on Reverse Side <br />