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Form 3160-5 UNITED STATES FORM APPROVED <br />(June 1990) DEPARTMENT OF THE INTERIOR Budget Bureau No. 1 004 <br /> 1993 Ex Tres: March 31,1993 <br />,1993 <br />BUREAU OF LAND MANAGEMENT 5. Lease Designation and Serial No. <br /> Yankee Gulch CO-118328 <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. 6. If Indian, Allottee or Tribe Name <br />Use "APPLICATION FOR PERMIT-" for such proposals NIA <br />SUBMIT IN TRIPLICATE 7. If Unit or CA, Agreement Designation <br /> N/A <br />1. Type of Well 8. Well Name and No. <br />? Oil Well ? Gas Well O Other Nacholite Solution Mining American Soda L.L.P. 20-33 <br /> EPA Class III C03858-04560 <br />2. Name of Operator 9. API Well No. <br />American Soda, L. L. P. <br />3. Address and Telephone No. 10. Field and Pool, or Exploratory Area <br />2717 County Road 215, Parachute, Colorado 81635 Central Piceance Creek Basin <br />4. Location of Well (Footage, Sec., T., R., M., or Survey Description) 11. County or Parish, State <br />12,163.03 Easting SE '% of SW % of Section 20, T1S, R97W 6"' P.M. Rio Blanco, Colorado <br />13,238.53 Northing <br />12. CHECK APPROPRIATE BOX(s) TO INDICATE NATURE OF NOTICE, REPORT OR OTHER DATA <br />TYPE OF SUBMISSION TYPE OF ACTION <br />? Notice of Intent ? Abandonment ? Change of Plans <br /> ? Recompletion ? New Construction <br />? Subsequent Reports ? Plugging Back ? Non-Routine Fracturing <br /> ? Casing Repair ? Water Shut-Off <br />OFinal Abandonment Notice ? Altering Casing ? Conversion to Injection <br /> ? Other ? Dispose Water <br /> (Note Report results in multiple completion on Well <br /> Completion or Recompletion Report and Log form. <br />13. Describe Proposed or Completed Operations (Clearly state all pertinent details, and give pertinent dates, including estimated date of <br />starting any proposed work. If well is directionally drilled, give subsurface locations and measured and true vertical depths for all <br />markers and zones pertinent to this work.)* <br />• Well 20-33 dissolution surface at 1642'. Cast Iron Bridge Plug set at 1700' on 7" short string. <br />• On 9/10/2008 the 7" short string failed MIT. <br />• 12/19/2008 - Halliburton tripped coil tubing to the cast iron bridge plug at 1700' and pumped 350 sacks of <br />Type G cement, 15.8 #/gallon, 1.15 ft3/sack cement, slurry volume 402.5 ft3 in short string 7" casing. <br />• A cap is in place on the short string casing indicating the date of plugging and abandonment and the well <br />identification. <br />The wellhead is not cut down at this time since the long string 7" casing remains after passing MIT on <br />9/11/2008. <br />14. T hereby certify that the foreg g is true and correct. <br />Signed _T'__ Title Plant Manager Date January27, 2009 <br />(This space for Federal or State office use) <br />Approved by <br />Conditions of approval, if any: <br />Title 18 U.S.C. Section 1001, makes it a crime for any person knowingly and willfully to make to any department or agency of the United <br />States any false, fictitious or fraudulent statements or representations as to any matter within its jurisdiction. <br />*See Instruction on Reverse Side