Laserfiche WebLink
I <br />s <br />2 <br />Complete One (1) of Either Subsections A or l3; and Subsection C. <br />A. PERMANENT ABANDONMENT (Check the appropriate box and provide information) <br />Plugged dry hole, method of plugging: N?\E w , \Ne p ?C w,?,? N 1. `f S 3 <br />OF CEMC/?1'T D???veti:Eli 3 L.1l??SE ??vtZZ A(,C?S[Cc,?R'?.S ? ?hEEl?.e?' t (..p?, <br />Depth at which concrete plug set: O feet below ground surface. <br />?Sealed Hole: <br />1-1 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 />Marsh Funnel viscosity of abandonment fluid: sec. <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 />8. 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 />C. METUOII? OF RECLAI.MINO DRILL SITE I9IST[;R.BANCE; 5 ? <br />_.....__.._ R? _._ S?_t._....._zg. G st A fA <br />,qe.?p SECbfp . i s s! <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 />1?2i S ? ? l H.S.. <br />Name of Operator's Representative: Sc-ft"\Q N Title: SLAT 04b -A QeA L ?z e o 5??tv? ccs ?.? ? . <br />Signature of Operator's Representative: S2 Date:. tv ,s t a <br />_.._....._......... _................_. W .__._... _.......... ............... _... _. <br />M'a»in\share\F'rospectinl; F°orms\bli Abandonment Final Rpt.doc;