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Form 3160-5 UNITED STATES <br />(September 20D1) DEPARTMENT OF THE INTERIOR <br />BUREAU OF LAND MANAGEMENT <br />SUNDRY NOTICES AND REPORTS ON WELLS <br />Do not use this corm for proposals to drill or to re-enter an abandoned well. <br />Use Form 3160 - 3 (APO) for such proposals. <br />5. Lease Serial No. <br />Sodium lease C-0118327 <br />6. If Indian, Allottee or Tribe Name <br />EPA pernut CO 30358-00000 <br />SUBMIT IN TRIPLICATE-Other instructions on reverse side. <br />1. Type of Well <br />Oil Well Gas Well Other 1 Sodium Bicazbonate <br />_ Solution mining injector <br />2. <br />7. If Unit or CA/Agreement, Name <br />and/or No. <br />Natural Soda, Inc. <br />8. Well Name and No. <br />lA-4HI <br />FORM APPROVED OM B No. 10040135 <br />Expires: January 31, 2004 <br />AQQiess 3D. 1'nOne 1V O. linc(uae area <br />3a. 3200 County Road 31, Rifle Colorado 81650 code) 970-878-3674 <br />10. Field and Pool, or Exploratory <br />3. Location of Well (Footage, Sec., T., R., M., or Survey Description) Area <br />394 FNL 977 FWL Section 35 T1S R98W Boies-Bed/saline zone Cavi lA <br />11. County or Pazish, State <br />Rio Blanco ,Colorado <br />TYPE OF SUBMISSION <br />^ Notice of Intent <br />. Subsequent Report <br />^ Final Abandonment <br />Notice <br />LJ Acidize <br />^ Alter Casing <br />^ Casing Repair <br />^ Change Plans <br />^ Convert to <br />Injection <br />TYPE OF ACTION <br />Deepen <br />Fracture Treat <br />New Construction <br />Plug and Abandon <br />(Start/Resume) <br />^Reclamation <br />^Re-complete <br />^Temporazily Abandon <br />^ Water Disposal <br />Integrity <br />13. Describe Proposed or Completed Operation (clearly state all pertinent details, including estimated starting date of any proposed work and approximate <br />duration thereof If the proposal is to deepen directionally or re-complete horizontally, give subsurface locations and measured and true vertical depths of all <br />pertinent mazkers and zones. Atmch the Bond under which [he work will be performed or provide the Bond No. on file with BLMBIA. Required subsequatt <br />reports shall be filed within 30 days following completion of the involved operations. If the operation results in a multiple completion or recompletion m a new <br />interval, a Form 3160-4 shall be filed once testing has been completed. Final Abandonmart Notices shall be filed only after all requirements, including <br />reclamation, have been completed, and the operator has determined that the site is ready for final inspection.) <br />Rigged up on well. Attempted to pu115-1/2 inch injection string. Ran cutter and cut 5-1/2 in @ 2220 ft. Pulled 2220 ft of 5-1/2 casing out of well. Set CffiP @ <br />2210 ft. Pumped 40 sacks 15.8 # cement Tagged cement @ 1940 ft. Pumped 250 sacks 12.4 # cement to surface. 24 Sept 2004 grouted tubing displacement to <br />surface and installed dry hole mazker. <br />I4. I hereby certify that the foregoing is true and correct <br />Name (PrintedlTyped): Rodnev A. Storev Title: WELL FIELD SUPER <br />Sigrtature: <br />04 October, <br />' THISSPACE FOR FEDERAL OR STATE OFFICE USE <br />Approved by: <br />Title: <br />Conditions of approval, if any, are attached. Approval of this notice does not warrant or <br />certify that the applicant holds legal or equitable title to those rights in the subject lease <br />which would entitle the applicant to conduct operations thereon. <br />Title 18 U.S.C. Section 1001 and Title 43 U.S.C. Section 1212, make it a crime for any person knowingly and willfully to make to any <br />department or agency of the United States any false, fictitious or fraud ulent statements or representations as to any matter within its <br />jurisdiction. <br />(Instructions on pnge 2) <br />