2011-07-11_GENERAL DOCUMENTS - C1981041

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Form No. GWS -09 6/2006 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER 821 Centennial Bldg., 1313 Sherman St., Denver, CO 80203 (303) 866 -3581 Fax (303) 866 -3589 http: / /www.water.state.co.us For Office Use Only WELL ABANDONMENT REPORT Use to report plugging and sealing of permitted wells, monitoring and other holes. Type or print in black or blue ink. Instructions and plugging standards are on reverse side of form. Well Permit Number of the well being plugged 205585 or MH File Number MH- Hole ID # /Name 3o\1i t,s # 2 Individual /Company responsible for plugging and sealing the well: NAME(S) Himes Drilling Company, Inc. Mailing Address 2390 Highway 6 & 50 City, St., Zip Grand Junction, CO 81505 Phone ( 970 ) 242 -8893 Well (Hole) Owner: NAME(S) Snowcap Coal Company Phone ( 970 ) 241 -8118 Mailing Address, City, St., Zip Po Box 1428, Palisade CO 81526 ACTUAL WELL LOCATION: County Mesa Property Address, City, St, Zip 3968 I 9/10 Road, Palisade CO 81526 NE 1/4 of the SE 1/4, Sec. ? , Twp. 10 • N. or 0 S., Range 98 0 E. arm W., 6 P.M. Distance from Section Lines 1656 Ft. From • N. or 0 S., 1188 Ft. From i! E. or • W. Line. Subdivision Name Lot , Block ; Filing /Unit Optional: GPS well location information in UTM format. You must check GPS unit for required settings as follows: Format must be UTM, zone 12 • or zone 13 Ell ; Units must be meters; Datum must be NAD83; Unit must be set to true north. Easting Northing I (we) report the existing well (hole) was plugged and sealed on the date of May 17, 2011 for the following reason(s): 14 The well was plugged and sealed as required under Well Permit Number 205585 . • The well was not in use and was plugged and sealed. • Other (please explain) The well was plugged with the following materials placed at the indicated intervals: Amount and Type of Material Method of Placement Interval Portland Cement Type I /IT Tremmie from 276 feet to 3 feet from feet to feet from feet to feet Intervals of casing removed /ripped in feet - Surface sections removed from 3 feet to c feet Report must be signed by person who performed the well plugging work or by the well owner if this person is unknown or not reachable. I (we) have read the statements made herein, know the contents thereof, and that they are true to my (our) knowledge. Signatur_,p) Please print the Signer's Name & Title Tim Himes, CO LTC 531 Date May 19, 2011 Hines Drilling Company, Inc. It is the responsibility of the well owner to have the well /hole properly plugged and sealed. The Well Construction Contractor is responsible for notifying the owner of this requirement.