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<br />vA <br />2 <br />Marsh Funnel viscosity of abandonment fluid: <br />Type of surface plugging used: <br />Depth at which plug set: _ feet below ground surface, <br />Method: <br />sec. <br />Wpther 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. <br />Complete One (1) of Either Subsections A or B. and Subsection C- <br />A. PERMANENT ABANDONMENT (Check the appropriate box and provide information) <br />Plugged dry hole, method of plugging: Nom lidos.. Svtt-Efl __ w?T» N 1.15 ?,oy3 <br />of CAMttuT 1?C>>v b I W???tE K?ytr^2 1A44Rkr?+A -jC?. SHCo-iil ?ovt2 <br />Depth at which concrete plug set: O feet below ground surface. °F "' °' z5 yes 3 <br />?Sealed Hole: <br />F1 Neat Cement Grout, top to bottom: grout mixture used: <br />FINeat 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 />B. CONVERSION TQ_A WATER WELL <br />State Engineer's Permit No.: (attach copy of permit) <br />County Where Well is l;.ocated: <br />Water. Well Use: <br />C. MIST. IA.±G F RECLAIMIN&G3 DRILL, SITE DISTURBANCE; ,5.?? ?1?? __?i?...._??..._?.?.?.------??N31 <br />s'? .-...Z3?..'_°._Z.... _.. <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 />its, t't"j,,T <br />Name of Operator's Representative: _ / -A Y.-._w . Sc,gt.?1??_?__._ Title: %-A cAostYWIVI <br />Signature of Operator's Representative: ? -A? bate. z. t ? I o <br />M `amintshare\lls-(npecting FormsU)II Abandonment Final Rpt.doc