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Attachment D <br />2 <br />Complete One (1) of Either Subsections A or B; and Subsection C. . <br />A. PERMANENT ABA,NDONMEN'T (Check the appropriate box and provide information) <br />( ) Plugged dry hole, method of plugging: <br />Depth at which concrete plug set: feet below ground surface. <br />(Q Sealed Hole: <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: $a?er d; <br />c2O% So145 Qvick Grv,r4- <br />Match Funnel viscosity of abandonment fluid: <br />Type of surface plugging used: C'emen+ <br />Depth at which plug set: 3-13 feet below ground surface, <br />Method: POO red Ge,w% en f , 7`r w+ tm; " & v i ck G ro,) f, <br />( ) Other method used with approval of the Division of R,eclatnation, Mining and Safety; describe in <br />detail method and materials used on a separate attached sheet. <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 />C. METHOD OF RECLAIM GG DRILL SITE pISTU <br />&axck p' fie A w r? rvt -J e,;la j be,, ea 4' k <br />5prt'j'J fk.- Arlllra GvlflVaT'e?_anpt <br />dp4w-ow. P f an.i;,-3 '5e 0.sot1. <br />The Operator who conducted the prospecting drill operation states <br />best of their knowledge. <br />Name of Operator's Representative: _?>A "r Tt0 4 o rp <br />Signature of Operator's Representative: <br />> q0 <br />sec. <br />ftB Ai`i 1: b r 11 ik Pd - S Wert <br />fiaesell , Tapr7a;1 wi f &V_ <br />?lleu:f du?E <br />aPP ('eveu? Seed nit X °r'P "g, <br />that the information set forth hereupon is true to the <br />Title: _ 6E:0 L 0 6,1 ST <br />Date: 10/ 1 I0 q <br />WnriinlshwvUMwpeeting rwmW)H Abandonment Final Rpt.doc