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<br />z <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 />P <br />lugged dry hole, method of plugging: ?4a\a FA\eD Fscrv% SvQfA<E w.-ry ?+ ?.1S yas 3 <br />7 <br />off' CCMCI4r Dek1VETtkz 3 1?+H?5E ??vf4t,. A44Rk6 SES 'T52+atY.. <br />Depth at which concrete plug set: o <br />?Sealed Hole: <br />FINeat Cement Grout, top to bottom: <br />feet below ground surface. <br />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 />Marsh Funnel viscosity of abandonment fluid: see. <br />Type of surface plugging used: <br />Depth at which plug set: feet below ground surface, <br />Method: <br />W?ther 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 />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 Case: <br />Tb 3F <br />C. iMET. OD.OF RECLAIMING DRILL SITE D1STL RBA1NCEa ..., ,,...__S' 'J.5zE.....C? ?. <br />-230-0 <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 />?S??eKr <br />Name of Operator's Representative: __Mfl Rk w . SCfl??`o n? ?_rv Title: <br />Signature of Operator's Representative- .... _ ..... .......... late:...... ?'°.-I z , <br />WinW,,hareTrospecting For msU)fi Abandonment Final Rptdoc: