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Form Approved UMB No 2040-0042 Approval Fixpires b-30.9 <br />`~~~ UNITED STATES ENVIRONMENTAL PROTECTION AGENCY <br />WASI-BNGTON, DC 20960 <br />PLUGGING AND ABANDONMENT <br />NAME. AND ADDRF$$ OF FACILITY <br />American Soda LL.P, <br />27991 County Road 5 <br />Rifle. Co, 61650 NAME AND ADDRESS OFOWNER/OPERATOR <br />Amerion Soda L.L.P. <br />2717 ComTy Road 275 <br />Paza2hure, Co, 81635 <br /> <br />LOCATE WELL AND OUTLINE UN[T ON <br />SECTION PLAT -640 ACRES SLATE <br /> <br />CO. COUNTY <br /> <br />Rio Blanco PERMTi NUMBER <br /> <br />C03858-04557 <br /> <br />N SURFACE LOCATION DFSCRIPCION <br />SW Y~, SW Y., SE Y., SecROn 2D, Township 1S Range 97W <br /> LOG\TE WELL PI TWO DIXECIIONS FltOM NEAREST LPIFS OF QDARTER SECTION AND DRdLP1G IRJII <br /> Surface <br />450' FSL 13275.64 Northing <br /> 2350' FEL 12756.92 Fastln <br /> TYPE OF AUIT30RIZATION WELL ACTIVITY <br />W E X Individual Perndt <br />o Area Permit CLASSI <br />o CLASS II <br /> o RWe p Brine Disposal <br />o Enhanced Recovery <br /> Number of Wells _1_ o Hydrocazbon Storage <br />D Cf.A55l0 <br /> X Side by Side Dual T' Casing Complefion <br />S - Lean Name Yankee Gukh Well Number 20.30 <br />CASING AND TUBING RECORD AFTER PLUGGING METHOD OF EMPI,ACEMEM OF CEMEN7 PLUGS <br />SIZE WT(LB/I'D TO BE PVC PI WELI(IT) TO BE LEFT PI W ELL(FO HOLE S~ O The Balance Method <br />2d' 53 0 60' 24" D The dump Bailer Methal <br />T' 26 0 1899' 19" O The Two-Plug Method <br />i' 26 0 2214' 19" X Other <br /> Coil Tubing Unit <br />CEMENTING TO PLUG AND ABANDONED DATA PLUG #1 PLUG #2 PLUC #3 PLUG #4 PLUG #5 PLUG #6 PLUG #7 <br />Size of Hole or Pi in which Plu Will Be Placed inches T' Con 7" Short <br />De to Bottom oETubin or Drill Pi k 1660 1660 <br />Sacks of Cement Used each lu 230 247 <br />SI Volume Pum d Or. k 356.5 3829 <br />Calculated To of Plu k) Surface Surfare <br />Measured To of Plu if m ed k Surface SurPare <br />SI Wt b./Gal. 15.6 15.6 <br />T cement or other material Class T G T G <br />LIST ALL OPEN HOLE AND/O R PERFORATED INTERVALS WHERE CASING WILL BE VARI ED (i art ) <br />From To From To <br /> <br /> <br /> <br /> <br /> <br />flease reference attached BLM Sundry Form <br />CERTIFICATION <br />f certify undo the penalty of the Imu that I have persolm(ly emmined and am familiar with the informaNan <br />submitted in this donmrent and al( attachments arW that, based ort my inquiry of those irWividuals <br />immediately rcspansible for obtaining the information, 16efieae that the information is true, accurate, <br />and complete. I am aware tMt there are sigmfimnt prnalties for submitting false irtfomuNon, iuWdfng <br />the possibility of fine and Emprisanment (Ref. 40ffR19432 <br />NAME.4ND OFFICIAL TITLE (Please type or pent) <br />Max Famey Piceance Operartons Manager SIGNAN <br />(~.~ DATE SIGNED <br />September 14, 2004 <br />EPA Form7520.14 / <br />