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FORM NO. <br /> <br />GWS-31 <br />04/2005 <br />WELL CONSTRUCTION AND TEST REPORT <br />STATE OF COLORADO, OFFICE OF THE STATE EliglNEER <br />1313 Sherman St., Room 818, Denver, CO 80203 <br />Phone - Info (303) 866-3587 Main (303) 86&3581 <br />Fax 303 866-3589 http.-1ANww.water.st&te.co.6s <br />For Office Use Only <br />1. WELL PERMIT NUMBER: 49459-MH <br />2. WELL OWNER INFORMATION <br />NAME OF WELL OWNER: Exxon Mobil Corporation <br />MAILING ADDRESS: GSC-GP2-224, P. 0. Box 2567 <br />CITY: Houston STATE: TEXAS ZIP CODE: 77252 <br />TELEPHONE NUMBER: 281654-6246 <br />3. WELL LOCATION AS DRILLED: NW1/4, SW1/4, Sec. -7 Twp. 5 ? N or ® S, Range 95 ? E or N W <br />DISTANCES FROM SEC. LINES: 2359 ft. from ? N or ® S section line and 1182 ft. from ? E or ® W section line. <br />SUBDIVISION: , LOT , BLOCK , FILING (UNIT) <br />Optional GPS Location: GPS Unit must use the following settings: Format must be UTM, Units Owner's Well Designation: EF-V2 <br />must be meters, Datum must be NAD83, Unit must be set to true N, ? Zone 12 or ? Zone 13 Fasting: <br />STREET ADDRESS AT WELL LOCATION: Northin : <br />4. GROUND SURFACE ELEVATION 7157 feet DRILLING METHOD Air Rata <br />DATE COMPLETED 11/3/2010 TOTAL DEPTH 175 feet DEPTH COMPLETED 174 feet <br />5. GEOLOGIC LOG: 6. HOLE DIAM in. From ft To ft <br />Depth Type Grain Size Color Water Loc. 6.5 0 148 <br />0-17 Shale fine bbm&IK 155-160 6.125 148 175 <br /> <br /> 7. PLAIN CASING: <br /> OD (in) Kind Wall Size (in) From (ft) To (ft) <br /> 4.5 Certalok- .250 +1 129 <br /> 4.5 Certalo .250 169 174 <br /> <br /> <br /> PERFORATED CASING: Screen Slot Size (in):.032 <br /> 4.5 Certalok .250 129 169 <br /> <br /> <br /> <br /> 8. FILTER PACK: 9. PACKER PLACEMENT: <br /> Material Silica Type <br /> Size 8-12 <br /> Interval 120-170 Depth <br /> 0. GROUTING RECORD <br /> Material Amount Density Interval Placement <br />Remarks: Opened exploration hole 0'-149' <br />Deepened hole 149'-174' 3/8 i 1.5 bkt 170.174 dumped <br />3/8chio 1 bkt 115.120 dum d <br /> Grout 450 Gal 12# 115-0 pumped <br />11. DISINFECTION: Type I Amt. Used <br />12. WELL TEST DATA: Check box if Test Data is submitted on Form Number GWS 39 Supplemental Well Test. <br />TESTING METHOD Airlift <br />Static Level 154 ft. Date/Time measured: 114-2010 Production Rate <1 gpm. <br />Pumping Level ft. DateTme measured Test Length (hrs)1.0 <br />Remarks: Minimal production noted during airlifting <br />13. I have read the statements made herein and know the contents thereof, and they are true to my knowledge. This document is signed and certified In <br />accordance with Rule 17.4 of the Water Wen Construction Rules, 2 CCR 402-2. [The filing of a document that contains false statements is a violation of <br />section 37-91-108 1 e C.R.S., and is punishable fines u to $5000 and/or revocation of the contracts license. <br />Company Name: <br />Himes Drilling Company Phone: <br />(970)242-8893 License Number. <br />531 <br />Mailing Address. ,90 U. S. 6 and 50, Grand Junction Colorado 81505 <br />Signature: <br />;E?- A?? 1 Print Name and Title <br />Tim Himes Owner Date <br />11/29/2010 <br />