HYDRO26589

• Permit No: M1983194
• IBM Index Class Name: Hydrology
• Doc Date: 10/14/2004
• Doc Name: BLM Sundry Notices for Plugging and Abandonment and EPA Plugging Record for Injection Wells
• From: Natural Soda Inc.
• To: DMG
• Media Type: D
• Archive: No

Form 3160-5 UNITED STATES
(September 2001) DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
SUNDRY NOTICES AND REPORTS ON WELLS
Do not use this form for proposals to drill or to re-enter an abandoned well.
Use Form 3160 - 3 (APO) for such proposals.
SUBMIT /N TRIPLICATE-Other instructions on reverse side.
1. Type of Well
Oil Well Gas Well Other, Sodium Bicarbonate
Solution mining injector
INC
3a. 3200 County Road 31, Rifle Colorado 81650 code) 970-878-3674
3. Locaflon of Well (Footage, Sec., T., R., M., or Suraey Description)
298 FNL 673 FWL Section 35 T1S R98W
area
FORM APPROVED OM B No. 10040135
Expues: January 31, 2004
5. Lease Serial No.
Sodium lease C-0118327
6. If Tndian, Allottee or Tribe Name
EPA permit CO 30358-00000
7. If Unit or CA/Agreement, Name
and/or No.
Natural Soda, Inc.
8. Well Name and No.
3A-4H
10. Field and Pool, or Exploratory
Area
Boies-Bed/saline zone Cavity 3A
11. County or Parish, State
Rio Blanco ,Colorado
TYPE OF SUBMISSION ~ TYPE OF ACTION
^ Notice of Intent
^ Subsequent Report
^ Final Abandonment
Notice
LJ Acidize
^ Alter Casing
^ Casing Repair
^ Change Plans
^ Convert to
Injection
Deepen
Fracture Treat
New Construction
Plug and Abandon
(Start/Resume)
^Reclamation
^Re-complete
^Temporarily Abandon
^Water Disposal
r Shut-Off
Integrity
13. Describe Proposed or Completed Operation (clearly state all pertinent details, including estimated starting date of any proposed work and approximate
duration thereof. If the proposal is to deepen directionally or re-complete horizontally, give subsurface locations and measured and true vertical depths of all
pMinent mazkers and nines. Attach the Bond under which the work will be performed or provide the Bond No. on Sle with BLMBIA. Required subsequent .
reports shall be filed within 30 days following completion of the involved operations. If the operation results in a multiple completion or recompletion in a new
interval, a Form 3160-4 shall be filed once testing has been completed. Final Abandonment Notices shall be filed only after a]] requirements, including
reclamation, have been completed, and the operator has determined that the site is ready for Final inspection.)
Rig up on well. Run in well and cut 5-I2 tubing @ 2088 ft. Pull tubing. Casing paned @ 363 ft. Run in with spear. Can not free tubing. Release spear. Run in and
re-cut tubing @ 2028 ft. Run in with spear. Pull a112028 feet of tubing from well. Set CIBP in 7 in. @ 2020 R Cement Bottom 200 feet of well. Tag cement @
] 800 feet. Pump cement into well and getgood cement returns to surface. Grout well to surface and instal] dry hole marker.
l4. I hereby certify that the foregoing is [me and correct
Name
Signature:
Title: WELL FIELD
4 October,
THIS SPACE FOR FEDERAL OR STATE OFFICE USE
Approved by:
Title:
Conditions of approval, if any, are attached. Approval of Phis notice does not warrant or
certify that the applicant holds legal or equitable title to those rights in the subject ]ease
which would entitle the applicant to conduct operations thereon.
Office:
Date:
Title 18 ll.S.C. Section 1001 and Title 43 U.S.C. Section 1212, make if a crime for any person knazuingty and willfully to make to any
department or agency of the United States any false, fictitious ar fraudulent statements or representations as to any matter within its