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Form Approved UMB No 20960042 Approval Expires 6-30.9 <br />\~~~ UNITED STATES ENVIRONMENTAL PROTECTION AGENCY <br />WASHINGTON, DC 20960 <br />PLUGGING AND ABANDONMENT <br />NM1E AND ADDRFSG OF FACILfIY <br />American Soda L.L.P. <br />27991 County Road 5 <br />Rifle, Co. 81650 NAME AND ADDRESS OF OWNER/OPERATOR <br />American Soda LL.P. <br />2717 County Road 215 <br />Pazachute, Co, 81635 <br /> <br />LOCA'CE WELL AND OUTLINE UNIT ON <br />SECTION PLAT -640 ACRES SLATE <br /> <br />CO. COUNTY <br /> <br />Rio Bloom PERMIT NUMBER <br /> <br />C0365B-dM54 <br /> <br />N SURFACE LOCATION DESCRIPTION <br />[JE ~, NE ~/~ NE Y., Section 29, Township 1S Range 97W <br /> X <br />IACATE WELL M TWO DQtECTIONS FROM NEAREST I.BJES OF QDARTER SECTION AND DRB.LR4G IIt4If <br /> Surface <br />i10' FNL 12108,06 Northing <br /> 300' FEL 15078.43 Eason <br /> TYPE OF AUTHORIZATION WELL ACTIVITY <br />W E X Individual Permit <br />o Area Perndt CLAS51 <br />o CLASS II <br /> D RWe D Brine Disposal <br />p Enhanced Recovery <br /> Number of Wells _1_ o Hydrocarbon Storage <br />© CZASS BI <br /> Side by Side Duai T' Casing Completion <br />3 - Lease Name Yankee GWCh Well Number 29-53 <br />CASING AND TUBING RECORD AFIER PLUGGING METHOD OF EMPLACEMENT OF CEMENT PLUGS <br />S1ZE WT(I.B/FT7 TO BE I'tlT w WELI(FC) TO BE LEFL IN WELUFf) HOLE S~ O The Balance Method <br />20" S3 0 75' 24" O The dump Bailer Method <br />7" 26 0 1731' 19" D The Two-Plug Method <br />T' 26 0 1929' 19" X Other <br /> Cod Tubing Urdt <br />CEMENTING TO PLUG AND ABANDONED DATA PLUG #1 PLUG #2 PLUG #3 PLUG #4 PLUG #5 PLUG #6 PLUG #7 <br />Size of Hole or Pi in which Plu Will Be Placed inches) 7" n 7" Short <br />th ro Bottom of Tubin or Drill Pi (t 1700 1700 <br />Sacks of Cement Used each lu 256 259 <br />51 Volume Pus d ar. ft. 396.6 401.5 <br />Calculated To of Plu ft. Surface Surface <br />Measured To of Plu if to ed h. Surface Surface <br />gum Wt. Lb./Gal. 15.6 75.6 <br />T cement or other material Qass I T G T G <br />LIST ALL OPEN HOLE AND/OR PERFORATED INIERVAIS WHERE CASING WILL BE VARIE D (i a ) <br />From To From To <br /> <br /> <br /> <br /> <br /> <br />Please reference attached BLM Sundry Form. <br />CERTIFICATION <br />I certify under the pmolty of the Taw that f have personally emmiKdand am/amiliar with the information <br />submitted in this document andaR attackmrnts and that, based on my inquiry of thou individuals <br />immediately responsible for obtaining the infomation, I believe that tht information is true, accvmte, <br />and complete I am amore that there arc significant penalties for submitting/aLse information, including <br />the possibility of fine and imprisonment (Ref. 90 CFR 14432 <br />NAME AND OFFICIAL TITLE (Phase typt orprint) <br />Mass Famey Piceance Operations Manager SIGNATU DATE SIGNED <br />September 14, 2004 <br />EPA form 7520.14 / \ <br />