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Form 31645 UNITED STATES FORM APPROVED <br />Qune 1990) DEPARTMENTOF THEINTERIOR Budget eure°u Na 10040135 <br /> Ex ~u~ M°aF 31.1956 <br />BUREAU OF LAND MANAGEMENT s. tam Daignetion eM seri°INw <br /> Yankee Gulch CO-118329 <br />SUNDRY NOTICES AND REPORTS ON WELLS <br />Do not use this form for proposals to drill or [o deepen ox reentry to a different reservoir. 6. a I.dim~ mm~re o, T.,7K Nye <br />Use "APPLICATION FOR PERMIT-" for such N/A <br />SUBMIT IN TRIPLICATE r. v uaa °` cq Agreanent oe°ig.~aew^ <br /> A <br />1. Type of Web aweu Nmra °M Nn <br />^ Oil Well ^ Gas Well ®Other Nahcolite Solution Minim American Soda LLP 28.17 <br />2. Name of Operator 9. API Wea Na <br />American Soda, L.LP. <br />3. Address and Telephone No. 1a Fsld °^d Pooi ^. emI°r°I°aAre° <br />2717 C . Rd. 215 Parachute, CO 81635 970 285-6500 Central Piceance Cteek Basin <br />4. Location of Well (Footage, Sec., T., R., M., or Survey Description) n. cAway o<Perish Sl°le <br />5' S and 362' B of NW corner of Sec 28, TIS, R97W 6m PM Rio Blanco, CO <br />East' 15,494.38 Northin 12,896.63 <br />REPORT OR OTHER DATA <br />TYPE OF SUBMLSSION TYPE OF ACTION <br />^ Notice of Intent ®Abandonnlent ^ Change of Plans <br /> ^ Recompletlan ^ New Construction <br />^ Subsequent Reports ^ Pluggblg Back ^Nom-Routine Fracturing <br /> ^ Casing Repair ^ Water Shut-0ff <br />ISIFinal Abandonnlert[ Notice ^ Altering Casing ^ Conversion to Injection <br /> Other: ^ Dispose Water <br /> ~ a°pmt~vwinm°wpr~au0®®wm <br />16 wsme}1°Pmede~~PNMOP®~®+I~raee°n P°~°~~,mapx Pee^m,a.~n.atlvdmB ve®weamee~s~nmr~r P°P~vat ifwmudhatlm+~Y ~nm.Prt mamaae ~onu® <br />mt mamas ad hve "e11rtl dep W~ lm m m°drm as ~ pMOmt m mb vedcP <br />We112&17 dissolution surface at 1492'. <br />11/13/02 -11/14/02 Pulled all of the 41/z" short and long strings and set QBP at 1730' on both the long and short T' casings. <br />6/16/04 Cudd Pressure Control tripped to 1730 feet with cod tubing unit into long 7" casing string. Halll1nlrton pumped 246 sacks of 15.6 <br />#/gal Type G, 35% SSA, 0.2% CFR3 neat cement and displaced mil tubing with water. <br />6/16/04 Cudd Pressure Control Mpped to 1727 feet with mil tubing unit into short T' casing string. Hallilnlrtan pumped 246 sacks of 15.6 <br />#/gal Type G, 35% SSA, 0.2% CFR3 neat cement and and displaced mil tubing with water. (Please reference ASLLP Plugging and Long Term <br />Standby Summary) <br />7/7/2004 Stewart Welding cut off wellhead, rapped both casings, and labeled weB location on cap. <br />14. I hereby certify that the foregoing H true and correct. <br />Signed <br />('Reis spam for Federal or State office use) <br />Approved by <br />Conditions of approval, if any: <br />Title 18 US.C. Section 1001, makes it a aims for any person knowingly and willfully to make to any department or agency of the United <br />States any false, fictitiws or fraudulent statements or representations as to any matter within its jurisdiction. <br />'See Instruction on Reverse Side <br />