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Form 3160-5 UNITED STATES <br />(September 200:1) 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 re-enter an abandoned well <br />Use Form 3160 - 3 (APD) for such proposals. <br />SUBMIT IN TRIPLICATE-Other instructions on reverse side. <br />1. Type of Well <br />Oil Well ? Gas Well ? Other X <br />FORM APPROVED OM B No. 1004-0135 <br />Expires: August 31, 1985 <br />5. Lease Serial No. <br />Sodium lease C-0118327 <br />6. If Indian, Allottee or Tribe Name <br />EPA permit UIC C030358-00000 <br />7. If Unit or CA/Agreement, Name and/or <br />No: Natural Soda, Inc. <br />8. Well Name and No. <br />3A-5V <br />9. API <br />2. Name of Operator NATURAL SODA, INC <br />Address 3b. Phone No. (include area <br />3a. 3200 County Road 31, Rifle Colorado 81650 970-878-3674 <br />Location of Well (Footage, Sec., T., R., M., or Survey <br />TYPE OF SUBNESSION <br />l0.:Field and Pool, or Exploratory Area <br />Boies-Bed / saline zone <br />11. County or Parish, State <br />Rio Blanco, Colorado <br />TYPE OF ACTION <br />Acidize El Deepen <br />[] Notice of Intent ? Alter Casing El Fracture Treat <br />? Casing Repair [] New Construction <br />X Subsequent Report ? Change Plans X Plug and Abandon <br />? Convert to Injection <br />El Final Abandonment Notice <br />(Start/Resome) <br />[]Temporarily Abandon <br />[]Water Disposal <br />LJWater Shut-Ott <br />Elwell Integrity <br />[]Other <br />13. Describe Proposed or Completed Operation (clearly state all pertinent details, including estimated starting date of any proposed work and approximate <br />duration thereof. If the proposal is to deepen directionally or re-complete horizontally, give subsurface locations and measured and true vertical depths of all <br />pertinent markers and zones. Attach the Bond under which the work will be performed or provide the Bond No. on file with BLM/BIA. Required subsequent <br />reports shall be filed within 30 days following completion of the involved operations. If the operation results in a multiple completion or re-completion in a new <br />interval, a Form 316011 shall be filed. once testing has been completed. Final Abandonment Notices shall be filed only after all requirements, including <br />reclamation, have been completed, and the operator has determined that the site is ready for final inspection.) <br />Well 3A-5V was plugged and abandoned July 24, 2008. A description is attached to this Sundry notice. The Final Abandonment Notice will be submitted after <br />final reclamation. <br />14. I hereby certify that the foregoing is true and correct <br />Name (Printed/Typed): <br />Title: Manufacturing Director <br />Signature: <br />4VAgyL <br />THIS SPACE FOR FEDERAL OR STATE OFFICE USE <br />Approved by: <br />Title: <br />Office: <br />Conditions of approval, if any, are attached. Approval of this notice does not warrant or <br />certify that the applicant holds legal or equitable title to those rights in the subject lease <br />which would entitle the applicant to conduct operations thereon. Date: <br />Title 18 U.S.C. Section 1001 and Title 43 U.S.C. Section 1212, make it a crime for any person knowingly and willfully to make to any <br />department or agency of the United States arty false, fictitious or fraudulent statements or representations as to any matter within its jurisdiction. <br />(Instructions on page 2) <br />A