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r~ <br />I.. <br />T I <br />Form 3160-5 UNITED STATES <br />(June 1990) DEPARTMENT OF THE INTERIOR <br />BUREAU OF LAND MANAGEMENT <br />SUNDRY NOTICES AND REPORTS ON WELLS <br />Do not use this form for proposals to drill or to deepen or reentry to a different reservoir. <br />Use "APPLICATION FOR PERMIT-" for such proposals <br />SUBMIT IN TRIPLICATE <br />FORM APPROVEp <br />u Hurwu Na. 1004-0135 <br />5. l.eue Desigrution etd Serial No. <br />SODIUM LEASE C-0118327 <br />fi. If 1Mian, Allonee or Tribe Name <br />EPA PERMIT CO 3358-00696 <br />7. If Unit m CA, Agtwnrnt Iksigrution <br />,L type or wdl NATURAL SODA. INC. <br /> Oil G <br /> tr INJ. /REC. <br />^ Wdl ^ Well ®Ourcr g, Wdl Nama aM No. <br />2. Name of Operator NSI <br /> NATURAL SODA, INC. 9. API Well No. <br />3. Address aM Telcphane No. 6H <br /> B <br />31 RIFLE <br />CO 81650 <br />3200 R <br />C (970) 878-3674 <br /> . <br />. <br />. <br />, l <br />Fi <br />P <br />l <br />A <br />0 <br />H <br /> eld and <br />oo <br />, m <br />ommry <br />na <br />1 <br />. <br />ap <br />a. !oration of Well (Foouge, Sec., T., R., M., or Survey Desorption) BOLES BED / SALINE ZONE <br /> 1873.61 FEL, 399.7 FWL SEC 26 II. County or Parish, Sute <br /> N. 229724.2 E. 1199191.63 RIO BLANCO, CO. <br />Iz. CHECK APPROPRIATE BOX(s) TO INDICATE NATURE OF NOTICE, REPORT, OR OTHER DATA <br /> TYPE OF SUBMISSION TYPE OF ACTION <br /> ^ Notice of In[en[ ^ AbaMamnen[ ^ Change of Plam <br /> ^ Retompleticn ^ New Conswction <br /> Subsequent Report ®Plugging Hack ^Nora-Routine Factoring <br /> ^ Cuing Repair ^ Wamr Shm-0ff <br /> ^ Fiiui Abandomnent Notice ^ Altering Casivg ^ Conversion td lnjxtion <br /> ^ Other ^ Dispose Wa[er <br /> (Nmr. Rayon rnuluof muhipkcomplttionon wdl <br /> Complaion or Recompltt,on 0.epon aM Lo6 farm.) <br />13. Describe Proposed or Completed Opemdom (Clearly .ttate all pertinent deuikc, and give pertinent dates, ittGUding cs[ima[ed date of smnin8 ~Y ProPOS~ work. If weH u ditatiormllY drilled, <br /> give subsurface lontiorts end mrasurtd and true vertical depths (ar all marker aM zones peninrnt ro this work.)• <br /> RIG UP SERVICE RIG AND PULL 4 1 /2" INJECTION LINER STANDING. <br /> RUN IN HOLE WITH CIBP ON 2 7/8" TUBING AND SET AT 3020: FT. INSIDE 5 1/2" 15.35// CSG. <br /> RUN IN HOLE WITH TCP GUNS ON 2 7/8" TUBING. PERFORATE FROM 3019. S..FT. TO 2999.5 FT. <br /> AT 4-SH/FT. <br />RUN IN HOLE WITH 4 1/2" INJECTON LINER. <br />BUTTON UP WELLHEAD AND RIG DOWN. <br />rc. r nereoy a try tMt g -and Wrrect \ <br />signed ritie CONSULTANT - Dam 12-23-03 <br />Clyde space for Federal or Su¢ office uu) <br />Appmved by Title Deu <br />Catdiuons of approval, if any: _ <br />Titre 18 U.S:C. Section 1001, makes it a mimc for any person knowingly and willfully to make m any deparmtad or agenry of the United Sates any false, fictitious dr fraudulent summetna <br />or reprearnutiona as m sny maser within its jurisdiction. <br />•Ses Inetructlon on Rsveroe Slde <br />