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
(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 (APD) for such proposals.
SUBMIT IN TRIPLICATE-Other instructions on reverse side.
1. Type of Well
Oil Well Gas Well Other, Sodium Bicarbonate
Solution mining recovery
INC
Address
3a. 3200 County Road 31, Rifle Colorado 81650
Location of Well (Footage, Sec., T, R., M., or Surv
3358 FNL 3365 FEL Section 26 T1S R98W
TYPE OF SUBMISSION
^ Notice of Intent
^ Subsequent Report
^ Final Abandonment
Notice
^ Acidize
^ Alter Casing
^ Casing Repair
^ Change Plans
^ Convert to
Injection
3b. Phone No. (include area
code) 970-878-3674
FORM APPROVED OM B No. 1004-0135
Expires: January 31,2004
5. Lease Serial No.
Sodium lease C-0118327
6. If Indian, Allottee or Tribe Name
EPA permit CO 30358-00000
7. If Unit or CA/Agreement, Name
and/or No.
Natural Soda, Inc.
ts. well Name and rvo.
2A-2V
10. Field and Pool, or Exploratory
Area
A groove aquifer
11. County or Parish, State
Rio Blanco .Colorado
TYPE OF ACTION
Deepen
Fracture Treat
New Construction
Plug and Abandon
(Start/Restune)
^Reclamation
^Re-complete
^Temporarily Abandon
^ Water Disposal
^ Water Shut-Off
^ Well Integrity
^ Other
Conversion to
Water Supply
Well
13. Describe Proposed or Completed Operation (clearly state al] 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 zones. Attach the Bond under which the work will be performed or provide the Bond No. on file with BhM/BIA. Required subsequent
reports shall be filed within 30 days following completion of the involved operations. If the operation results m a multiple completion or re-completion in a new
interval, a Fonn 3!60-0 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.)
Run in well and set 4-l/2 inch cast iron bridge plug ®1920 inside 4-1/2 inch liner.
Pump cement plug, 15.8 # class G cement from 1920 to L500 fee[ inside 7 inch casing.
Perforate, 6 shoots per foot, inside 7 inch from 1400 to 1420 feet across the "A" aquifer interval.
Run in well with 4-1/2 inch tubing and electric submersible pumping equipment to produce raw water for operations.
l4. I hereby certify that the foregoing is tme and correct
Name (Prinled/Typed): Rodnev A. Storey Title: WELL FIELD SUPERVISOR
Signature:
13 May,
THIS SPACE FOR FEDERAL OR STATE OFFICE USE
Approved by:
Title:
Conditions of approval, if any, are attached. Approval of this notice does not warrantor
certify that the applicant holds legal or equitable title to those rights in the subject lease
which would entitle the applicant to conduct operations [hereon.
Date:
Title IS 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
department or agency of the United States any false, fictitious or fraudulent statements or representations as to any matter within its
jurisdiction.
Office:
(Instructions on page 2)