REP16554

• Permit No: M1999002
• IBM Index Class Name: Report
• Doc Date: 8/5/2004
• Doc Name: Plugging and Abandonment of Wells & Reports
• From: American Soda LLP
• To: DMG
• Media Type: D
• Archive: No

Form 31605 UNFFED STATES Powa APPROVSo

Qune 1!)90) DEPARTMENT OF THE INTERIOR eudgel Eureeu Nn 1OD40135

'
Ez
es Meeeh31, 1590
BUREAU OF LAND MANAGEMENT s. levee Designation end Saud Nn
Yankee Gulch 00.118328
SUNDRY NOTICES AND REPORTS ON WELLS
Do not use this form for proposals to drill or to deepen or reentry to a different reservoir. e a tw+ee. Atbaee orT.;be Nen,e
Use "APPLICATION FOR PERMIT-" for such N/A
SUBMFCINIRIPLICATE ~. uu.wmCA, Agee~ent Dm~gn°a°°
A
1. Typf!Of WeH & WellNmiemd Nn
^ Oil Well ^ Gas Well ®Other Nahtolite Solution Minis American Soda LLP 21-15
2 Name of Operator 9. API Well Nn
American Soda, L.L.P.
3. Address and Telephone No. to Pield a.d Pen4 m EaPbremry Area
2717 Ct . Rd. 215 Parachute, CO 81635 970 2856500 Central Pireance Creek Basin
4. Location of Well (Footage, Sec., T., R., M., or Survey Desuiption) tt. CnumY orPerish, seem
H 15,153.98 and N13413.68 SW Yi of SW Yi of Section 21, TLS, R97W bs P.M. Rio Blanco, CO
TYPE OF SUBML$ION
^ Notice of Intent
^ Subseaptmt Reports
®Final Abandonment Notice
REPORT
® Atumdonment ^ Change of Plans
^ Recompletion ^ New Construction
^ Plugging Back ^Nos-Routine Fracturing
^ Casing Repair ^ Water Shut-0ff
^ Altering Casing ^ Conversion to Injection
Other: ^ Dispose Water
(team aePo.eroraammoluplecamplea®®Wm
]3. Daribe rupoea orc®WaNOpmuma(Oaeif Nmmre+mmtaeeNe, maghrepaemmtmm.mrldmgamt,ma a.tr Naawsmr Pe^wem••^~ u.meaoa.;m.g aemM. peamnes mres®.
em meomm saa wr reuse ayem re m ~ mamas pvuemt m ua..exr
WeH 21-15 dissolution setrfam at 1946'.
3/29/df Rig up Key Euergy on weH.
3/30/09 Cut 4 yr" short string at 1690'.
3/31/04 Pulled 1690" of the 4 yx" short string. Set bridge plug ~ 1655'.
4/1/04 PuOed all of the 4 yz" long string (2218') and set bridge plug at 1655'
6/18/04 Cudd Pressure Control tripped to 1657 feet with coil tubing unit into long 7" casing string. Hallrburton pumped 246 sacks of 15.6
k/gal Type G, 35% SSA, 0.2% CFR3 neat cement and displaced m8 tubing with water.
6/21/04 Cudd Pressure Control tripped to 1516 feet with mil tubing unit into short 7" casing string. Hallilnrrton pumped 225 sacks of 15.6
#/gal Type G, 35% SSA, 0.2% CFR-3 neat cement and circulated 1 sack of cement to surfare. (Pl~se reference ASLLP Plugging and Long
Term Standby Summary)
7j 8/2004 Stewart Welding cut oft wellhead, capped both casings, and labeled well location on rap.
14. I hereby certify that the foregoing is tme and mnect.
Signed
(This space for Federal or State office use)
Approved by
Conditions of approval, if any:
Title 18 US.G Section 1001, makes 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
`See Instruction on Reverse Side