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Form Approved UMB No 20460092 Appmval Expires 6-30-9 <br />\~~~ UNITED STATES WNV~IRO Gl'ON DCP20460 CHON AGENCY <br />PLUGGING AND ABANDONMENT <br />NAME AND ADDRESS OF FACII,RY <br />American Soda LL.P. <br />27991 County Road 5 <br />Rifle, Co, 81650 NAME AND ADDRESS OF OWNER/OPERATOR <br />Ameritan Soda LLP. <br />2717 County Road 275 <br />Parachute, Co, 81635 <br /> <br />LOCA'L'E WELL AND OUTLINE UNIT ON <br />SEC770N PLAT -640 ACRES SCA7E <br /> <br />CO. COUNTY <br /> <br />Rio Blanco PERMIT NUMBER <br /> <br />C0385&04569 <br /> <br />N SURFACE LOCATION DESCRIPCION <br />NE Y., NE Y., LYE Y., Section 29, Township 15 Range 97W <br /> X <br />LOCATE WELL IN TWO DBtECE10N8 FROM NEAREST I.RJES OF QUARFER SECCION AND DRB,I.IIYG UNR <br /> Surface <br />2R FNL 1786978 Northing <br /> 20R FEL 14887.38 Eastin <br /> TYPE OF AUTHORIZATTON WELL ACTIVITY <br />W E X Individual Permit <br />p Area Permit CLASS I <br />o CLASS l] <br /> o Rule o Brine Disposal <br />D Enhanced Recovery <br /> Number of Wells `t_ p Hydraaz6on Srorage <br />O CLASS UI <br /> Side by Side Dual T' Casing Completion <br />S - Lease Name Yankee Cinch WeB Number 29-20 <br />CASING AND TUBING RECORD AFTER PLUGGING METHOD OF EMPLACEMENT OF CEMENT PLUGS <br />SIZE WT(I.B/FD TO BE PllT M WELUFn TO BE LEFC IN WELL(Fn HOLE S¢E O The Balance Method <br />ZO" 53 0 40' 24" O The dmnp Bailer Method <br />T' 26 0 ' 1797 15' O The Two-Plug Method <br />7" 26 0 2073' 19" X Other <br /> Coil Tubing Unit <br />CEMENTING TO PLUG AND ABANDONED DATA PLUG 791 PLUG N2 PLUG 713 PLUC N4 PLUG k5 PLUG 7t6 PLUG K7 <br />Size of Hale or Pi N which Plu Wi8 He Placed inches) T' n 7" Short <br />M Bottum of Tubin or Drill Pi EL 1590 1590 <br />Sacks of Cement Used each lu 278 718 <br />S! Volume Pum d cv. ft 353.4 453.4 <br />Calculaced7 of Plu ft Surface Surface <br />Measured To of Plu B to ed ft Surface Surface <br />Sl `Nt. b./Gal. 15.6 15.6 <br />T cement or other material Class T C T G <br />[.ISf ALL OPEN HOLE AND/O R PERFORATED INTERVALS 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 mtder the penalty of fhe lam that 1 hone personally emmiud and am familiar with the infarmahon <br />submitted in thfs dnrnmtnt and all attaehments atd that, baud on my inquiry of those individuals <br />immediately responsible far obmining the fnfommtion, l believe that the infommtion is hue, ammk, <br />and rampkte. I am mvare that there are signeJ't'tant prnaltks for submitting false informative, including <br />the possibility offrrre and imprisommenE (Ref. 40 CFR 14232 <br />NAME AND OFFICIAL TITLE (Plcau type oryrint) <br />Max Ramey Piceance Operations Manager SIGNATURE <br />(~„ DATE SIGNED <br />September 14, 2004 <br />FPA 9bam 752644 <br />