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Form 3160.5 UNITED STATES FORM APPROVED <br />Quite 7990) DEPARTMENT OF THE INTERIOR cudgel Bureeu Na 1lYMte135 <br /> Ex ~ Mnc1.31, 19Xt <br />BUREAU OF LAND MANAGEMENT s. laces Denigudion and sQiet Nw <br />SUNDRY NOTICES AND REPORTS ON WELLS Yankee Gulch 00.118328 <br />Do not use this Eorrn for proposals to drill or to deepen or reentry to a different reservoir. A utm~..~, Albltee orTrae Name <br />Use "APPLICATION FOR PERMIT-" for such ro e N/A <br />SUBMIT IN TRIPLICATE Y- u una orcA, Ag>em,e.,t o e;endion <br /> A <br />1. Type of Well a weu Name and Nu <br />^ Od Well ^ Gas Well ®Other Nahcolite Solution Minim American Soda LLP 28.41 <br />2. Name of Operator 9. API WeE Na <br />American Soda, L.LP. <br />3. Address and Telephone No. to FieldeM Pont or E:pbreroy Area <br />2717 C . Rd. 215 Parachute, CO 81635 970 28545W Central Piceance Creek Basin <br />4. Location of Well (Footage, Sec., T., R., M., or Survey Description) tt. co,aay or PerieF, Side <br />256' S and 537' E of NW corner of Sec 28, 715, R97W 6® P.M. Rio Blanco, CO <br />Eas ' 15,647.02 Northin 12,663.04 <br />12 CI-IECK APPROPRIATE BOX(s) TO INDICATE NATURE OF NOTICE, REPORT OR OTI1II2 DATA <br />TYPE OF SUBMLS6ION TYPE OF ACTION <br />^ Notice of Intent Iffi Abandonment ^ Change of Plans <br /> ^ Recompletion ^ New Construction <br />^ Subsequent Reports ^ Plugging Back ^Noit-Routine Fracturutg <br /> ^ Casing Repav ^ Water Shut-0ff <br />®Final Abandonment Notice ^ Altering Casing ^ Conversion to Injection <br /> Other: ^ Dispose Water <br /> (Nose Re~vt,aNnbmmple~pw®®wm <br />]3. Dev-wP.^P^wamC®pbad OpuNrm+lCbtl9 Mesa peavmtdaate, and nrxpv.bmt&trx ircledmgmtlmnee daedfWng mY pvapmMwmt llwx-bEhatim~-y AiDed, put ubnLaxbr~rl®a <br />mlmmmM®daeervmlaepmmecamukva ®demopwbmtmtlaewa3Y <br />Well 28-41 dissolution surface at 149T <br />2/22/02 through 2/23/02 -Pulled aU 41/i" short and long strings from weB. Set CIBP in both long and short T' maings at 1675'. <br />6/16/04 Cudd Pressure Control tripped to 1670 feet with mil tubing unit into long 7" ®sing string. Halbburton pumped 247 sacks of 15.6 <br />#/gal Type G, 35% SSA, 0.2% CFR~ neat cement and displaced mil tubing with water. <br />6/16/04 Cudd Pressure Control tripped to 1671 feet with roil tubing unit into short T' rasing string. Hatliln.rf.w. pumped 247 sacks of ]5.6 <br />#/gal Type G, 35% SSA, 0.2% CFR3 neat cement 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, capped both casings, and labeled well location on cap <br />14. I hereby certify that the foregoing is tme and coaect. <br />Signed <br />(This space for Federal or State office use) <br />Conditions of approval, tf any: <br />Title 18 US.C. Section 1001, makes i[ a crime for any person knowingly and willfully m make to any department or agency of the United <br />States any false, fic[iNous or fraudulent statements or representations as to any matter within its jurisdiction. <br />'See htstmction on Reverse Side <br />