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Form Approved UMB No 2M0-W42 Appmval Expires b369 <br />`ry~~ UMTED STATES ENVIRONMEMAL PROTECITON AGENCY <br />WASHINGTON, DC 20460 <br />PLUGGING AND ABANDONMENT <br />NAME AND ADDRESS OF FACILITY <br />American Soda LL.P. <br />27991 County Road 5 <br />Ritle, Co, 61650 NAME AND ADDRESS OFOWNER/OPERATOR <br />American Soda LL.P. <br />2717 CounW Road 215 <br />ParacEute, Co, 81635 <br /> <br />LOCATE WELL AND OU1'[.INE UNIT ON <br />SECTTON PLAT -640 ACRES SPATE <br /> <br />CO. COUNTY <br /> <br />Rio Blanco PERMIT NUMBER <br /> <br />C03&5&09558 <br /> <br />N SCiRFACE LOCATION DESCRIPFION <br />IVE Y, SE Y., SW Y., Section 20, Township IS Range 97W <br /> LIX'.ATE WELL PI TWO DBtF.CIIOtS FROM NEAREST LPIES OF QUARTER SECRON AND DRB.LING UNIT <br /> Surface <br />980' FSL 13779.04 Northing <br /> 2934 FWG 12429.33 Eason <br /> TYPE OF ALITHORIZATTON WELL ACTIVITY <br />W E X Individual Permit <br />p Area Permit CLASS I <br />p CLASS II <br /> D Rule o Brine DLsposal <br />D Enhanced Recovery <br /> X Number of Wells _1_ o Hydrocarbon Storage <br />~ CLASS III <br /> Side by Side Dual T' Casing Completion <br />S Lease Name Yankee Gulch Well Number 20.31 <br />CASING AND TUBING RECORD AFTER PLUGGING METHOD OF EMPLACEMEM OF CEMENT PLUGS <br />SiLE WT(LB/Fl) TO BE PVf W W ELL(FI') TO BE LEFT AI WELL(F17 HOLE SIZE O The Balance Method <br />ZlY' S3 0 8d 24" O The dump Bailer Method <br />T' 26 0 18(x5' 19"' D The Two-Plug Method <br />T• 26 o n6T' tv" X Other <br /> Coil Tubing Unit <br />CEMENFING TO PLUG AND ABANDONED DATA PLUG Nl PLUG 62 PLUG N3 PLUC N4 PLUG p5 PLUG W6 PLUG N7 <br />Size of Hole or Pi in which Plu Will Be Placed inches 7" n T'(Short <br />N to &rttom of 7ubin or Drill Pi ft 1633 1633 <br />Sacks of Cement Used each lu 233 230 <br />SI Volume Pum d N. ft 361.2 3%.5 <br />Calculated T of Plu fL Surface Surface <br />Measured To of Plu iE to ed fL Surface Surface <br />SI WL b./Gal.) 15.6 15.6 <br />T cement or other material Class III) T G T G <br />LISC ALL OPEN HOLE AND/O R PERFORATED INfERVAlS WHERE CASING WILL BE VARI ED (i an ) <br />From To Frpm To <br /> <br /> <br /> <br /> <br /> <br />Please reference attached BLM Sundry Form. <br />CERTIFICATION <br />I ¢rtify mWtr the penalty of the faro that I ham penowlly txamined and am familiar with tht infomwNon <br />submitted in this daamanrt and all atfachrrmrts artd that, based on my inquiry of thatt individaals <br />Emmediately xsponti6k for obtaining tht infonnaHOn, I believe that the infomu+Non is true, accuMk, <br />and rompktt. I am arvarc that [here are signiffcant penaltks for submittfngfalse information, including <br />the possibility office and imprisoronenL (Ref, 40 CFR 144.32 <br />NAME APJD OFFICIAL TITLE (Please type ar print) <br />Max Ramey Piceance Operatlorts Manager SIGNATU DATE SIGNED <br />September 14, 20114 <br />EPA Form 7520.79 <br />