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FoR.M STATE OF COLORADO NO OFFICE OF THE STATE ENGINEER G W S-9 818 Centennial Bldg., 1717 Sherman Sl., Denver, Colorado 80203 12/95 (307)866-1581 WELL ABANDONMENT REPORT (To Report Plugging and Sealing Wells) PERMIT NUMBER OF PLUGGED WELL Hole No. UC-3 NAME: Monteomerv Watson Minine Group Mailing Address: P O Box 774018 Ciry, S[., Zip: Steamboat Sorines CO 80477 Phone: 970/879-6260 Use Only Approval No. GWS9-96-OS ACTUAL WELL LOCATION: COUNTY: Routt PROPERTY ADDRESS: Havden Gulch Mine. Routt Countv Road 53 SE I/4 SE I/4, Sec. 30 Twp. 5 ®N. ~ S., Range 88 ~ E. ®W. P.M. Distances from Section Lines Ft. from ~ N. or ~ S. Line, Ft. from ~ E. or ~ W. Line. We report that an existing well was plugged and sealed for the following reason (s): ~ The well was plugged and sealed as required under the conditions of approval of Well Permit No. ~ The well was not in use and was plugged and sealed. Other (please explain) Ce.l ,~,w~- wra~r ~ivJ~~i ...e~~. aL~+V•. ~, Q~Y~ed' .r,~l/ ~IdY PV Y~/t` r'•~ O~ ~ei~/o DrJ~fi sn s The well was plugged and sealed according to the Water Well Construction and Pump Installation Rules on October 5. 1998. was omeeea with the touowme matenals placed at AAtOUN i AND TYPE OF MATERIAL METHOD OF PLACEMENT ~1 bags ~ cemenWentonite grout tremie from 0 feet to 181 feet. from feet to feet. from feet to feet. from feet to feet. tram feet to feet. from feet to feet. INTERVALS OF CASING REMOVED/RIPPED IN FEET from 0 feet to 2 feet. Cut off 2" P~-C and 6" steel protective casing, 0' - 2'. I have read the statements made herein and know the contents thereof, and that they are true to my knowledge. (Pursuant to Section 24-4-104 (13)(a) C.R.S., the making of false statements herein constitutes perjury in the second degree and is punishable as a class I misdemeanor.) 7 TIM HIMES,GeneralManager Dale: 10/13/98 Himes Drilling Company, Inc. 2390 Hwy 6 & 50. Grand Jct CO 81505 `T '~'v' 970/242-8893 INFORMATION - It is the responsibility of the well owner to have the well properly plugged and sealed. The well construction contractor is responsible for notifying the well owner of [he plugging and abandonment requvements. This form may be reproduced by photocopy or word processing means.