HYDRO28615

• Permit No: M1983194
• IBM Index Class Name: Hydrology
• Doc Date: 5/19/2004
• Doc Name: Injection Wells Conversion of Production Well 2A-2V to a Raw Water Supply Well
• From: Natural Soda Inc.
• To: DMG
• Media Type: D
• Archive: No

Form 3160-5 UNITED STATES FORM APPROVED OM B No. 1004-0135
(September 2001) DEPARTMENT OF THE INTERIOR Expires: January 31, 2004
BUREAU OF LAND MANAGEMENT 5. Lease Serial No.
SUNDRY NOTICES AND REPORTS ON WELLS Sodium lease C-0118327
Do not use this form for proposals to drill or to re-enter an abandoned well. 6. If Indian, Allottee or Tribe Name
Use Form 3760 - 3 (APO) for such proposals.
EPA permit CO 30358-00000
SUBMIT IN TRIPLICATE-Other instructions on reverse side. 7. if unit or CA/Agreement, Name
and/or No.
1. Type of Well Natural Soda, Inc.
Oil Well Gas Well Other' Sodium Bicazbonate -
Solution mining injector 8. Well Name and No.

2, Name of Operator NATURAL SODA, IlVC lA-4HI
9. API Well No.
Address 3b. Phone No. (include area
3a. 3200 County Road 31, Rifle Colorado 81b50 code) 970-878-3674
10. Field and Pool, or Exploratory
3. Location of Well (Footage, Sec., T., R., M., or Survey Description) Area
394 FNL 977 FWI
Section 35 T1S R98W Boies-Bed/saline zone Cavi lA
. 11. County or Parish, State
- Rio Blanco .Colorado
TYPE OF SUBMISSION TYPE OF ACTION
-^ Aodize ^ Deepen ~ Production ^Water Shut-Off
. Nofice of Intent
^ Alter Casing _ ^ Fracture Treat (Start/Resume) ^Well Integrity
^ Casing Repair ^ New Construction ~ ^Reclamafion ^Other
^ Subsequent Report ^Re-complete
^ Change Plans ^ Plug and Abandon
^ Final Abandonment ^ Convert to ^Temporarily Abandon
Notice Injection ^Water Disposal
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
pertinent markers and zone. Attach the Bond under which lire work will be performed or provide the Bond No. on file with BLM/BIA. Required subsequent
reports shall be filed within 30 days following completion of the involved operations. If the operation results in a multiple completion or re-completion in a new
interval, a Form 3160 shall be filed once testing has been completed. Final Abandonment Notices shall be filed only after all requirements, including
reclamation, have been completed, and the operator has determined that the site is ready for final inspection)
Rig up on well and attempt to pull all 5-1/2 inch tubing. Ifunable to pull all tubing, rrrn in well with tubing cutter and cut 5-1/2 inch tubing @ 2340 feet. Pull out
with 5-1/2 inch tubing. If unable to pull, cut 100 fee[ higher up well. Set 7 inch cast uon bridge plug @ 2340 feet. Pump 200 feet of cement on plug. Test casing
[0 300 PSI. Run in well and mg cement. Pump cement to surface. Cut off well head. Install P&A marker with all well identification on well casing. Reclaim well
area as designated by permit.
14. I hereby certify that the foregoing is true and coned
Name (Printed/Typed).~RodnevA Storev A Title: WELL FIELD SUPERVISOR
Signature: _~~~6JDate: 17IvtAY, 2004
v
TAIS SPACE FOR FEDERAL OR STATE OFFICE USE
Approved by: Title: Office:
Conditions of approval, if any, are attached. Approval of this notice does not warrant or ,
certify that the applicant holds legal or equitable title to those rights in the subject lease
which would entitle the applicant to conduct operatiohs thereon. Date:
Title IS U.S.C. Section 1007 and Title 43 U.S.C. Section 1212, make it a crime for any person knowingly and willfully to make to any
department or agency of the United States any false, fictitious or fraudulent stafements.or representations as to any matter wifhin its
jurisdiction.