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2 <br />Complete One (1) of Either Subsections A or B; and Subsection C. <br />A. <br />PERNIANENT ABANDONMENT (Check the appropriate box and provide information) <br />( ) Plugged dry hole, method of plugging: <br />Depth at which concrete plug set: <br />(X) Sealed Hole: <br />feet below ground surface. <br />( ) Neat Cement Grout, top to bottom: grout mixture used: <br />( ) Neat Cement Grout, interval grouting: grout mixture used: <br />Intervals grouted (feet beneath ground surface, method and materials): <br />( ) Abandonment Fluid Mixture (Such as Sodium Bentonite with Polymer) Brand Name: <br />Marsh Funnel viscosity of abandonment fluid. <br />Type of surface plugging used: <br />Depth at which plug set: <br />feet below ground surface, <br />Method: <br />(X) Other method used with approval of the Division of Reclamation, Mining and Safety; describe in <br />detail method and materials used on a separate attached sheet. See Attachment 2 <br />B. CONVERSION TO A WATER WELL <br />State Engineer's Permit No.: _ (attach copy of permit) <br />County Where Well is Located: <br />Water Well Use: <br />METHOD OF RECLAIMING DRILL SITE DISTt,RBANCE: Mud pit backf filled and <br />covered with available topsoil. Surface scratched and seeded with <br />................ ......... <br />BLM......rec.4zt1zX1eiid,ed.......ae .-cl m_i_xture_.-......._..__See.....At_tachment....._2......---................................ ........... _.............. <br />_ <br />The Operator who conducted the prospecting drill operation states that the information set forth hereupon is true to the <br />best of their knowledge. <br />NameofOperator's Representative: .Michael G. Leidich Citle:Manager - Lynx-Royal LLC <br />`signature of Operator's Represcntativ ' .. `_...._. late: <br />_.__..._. J"' .. ..1 <br />sec. <br />vl:`auin'45hare?.Pros}xctin? Fomis\01I Abandonment Final Rpt.doc