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Form Approved UMB No 2040-0042 Approval Expires 6349 <br />^~ UNITED SLATES ENVIRONMEMAL PROTECTION AGENCY <br />C WASHING70N, DC 204b0 <br />PLUGGING AND ABANDONMENT <br />NAME AND ADDRESS OF FACILITY <br />American Soda LLP. <br />7!991 County Road 5 <br />Rifle, Co, 81650 NAME AND ADDRESS OF OWNER/OPERATOR <br />American Soda LLP. <br />2717 County Road ri5 <br />Parachute, Co, 81635 <br /> <br />LOCATE WELL AND OUTLINE UNIT ON <br />SECTION PLAT -640 ACRES STATE <br /> <br />CO. COUNTY <br /> <br />Rfo Blanco PERMIT NUMBER <br /> <br />C0385B-045iB <br /> <br />N SURFACE LOCATTON DESCRIPFION <br />NE'/i, NW y, NE Y~, Section 29, Township 15 Range 97W <br /> X <br />LOCATE WELL Pl TWO DBiECC10N5 FROM NEAREST' IAIES OF QUARTER SECTION AND DRILLING UNIT' <br /> Surface <br />2a FNL 11B(1D.58 Northing <br /> tna FEL 13391.46 Eason <br /> TYPE OF AUTHORIZATTON WELL ACTIVITY <br />W E X Individual Permit <br />o Area Pemdt CLASS I <br />O CLASS II <br /> O Rule p Brine Disposd <br />O Enhanced Recovery <br /> Number of Wells _1_ O Hydrocarbon Storage <br />Ix7 CLASS III <br /> Side by Side IJual T Casing Completion <br />S Lease Name Yankee Gdch Well Number 29-68 <br />CASING AND TUBING RECORD AFTER PLUGGING METHOD OF EMPLACEMEM OF CEMEM PLUGS <br />SIZE WTO.B/F1') I'O BE Pl17IN WEL4Ff) 70 BE LEFT EV W ELL(FD HOLE SIZE O The Balance Method <br />2f Y' S3 0 68' 24" O The dump Hailer McH~od <br />T' 26 0 1852' 19" O The Two-Plug Method <br />T' ~ 0 2050' 19" X Other <br /> Coil Tubing Unit <br />CEMEMING 70 PLUG AND ABANDONED DATA PLUG #1 PLUG #2 PLUG #3 PLUG #4 PLUG #5 PLUG #b PLUG #7 <br />Stu of Hole m Pi N width Plu Will Be Placed inches T' n T Short <br />ro Bottom of Tubin Or Drill Pi fl 16% 7664 <br />Sarkg of Cement Used each Iu 237 733 <br />SI Volume Pum d (cu. ft 367.4 361.2 <br />CalcWated i of Plu fL) Surface Surface <br />Measured To of Plu if ra ed It Surface Surface <br />SI WL b./Gal. 15.6 15.6 <br />T cement or other material Class T G T G <br />LISP ALL OPEN HOLE AND/O R PERFORAT ED INTERVALS WHERE CASING W B.L BE VARIE D (i a ) <br />From To From To <br /> <br /> <br /> <br /> <br /> <br />Please reference attached BLM Sundry Forn <br />CERTIFICATION <br />I orrfffy veder the ptndty of the Imu Neat I bane persowtly eavanveed and am familiar rnitle the information <br />submitted in thfs datvurent and all attachments and than based nn my iregdry of those irdfoiduats <br />immedfahly responsible for obtaining the information, l betieoe that the Information is true, acnnaK, <br />and complete, I am amore that lherc are sigmffrant penalties for submitting false informoNon, incteeding <br />the possibility of ffne and nnyrisommtnt (Ref. ~t0 (3-R 144.32 <br />NAME AND OFFICIAL TITLE (Please type orprin0 <br />Max Ramey Piceance Operations Manager SIGNATURE DATE SIGNED <br />September 14, 2(104 <br />FPA Erorm 752414 ~ 1 <br />