2013-01-14_REVISION - P2012006

• Permit No: P2012006
• IBM Index Class Name: REVISION
• Doc Date: 1/14/2013
• Doc Name: Final Abandonment Report
• From: RPM, Inc.
• To: DRMS
• Type & Sequence: AR1
• Media Type: D
• Archive: No

Form No. I
GWS-09
4/2012
use to report
°annular gananded,
MORA OW
STATE OF COLORADO, OFFICE
821 Centennial Bldg., 1313 Sherman
[phone] Fax [phone]
OF THE
St., Denver,
shemanthlodthenadeaLa
STATE ENGINEER
CO 80203
For Office Use Only
WELL ABANDONMENT
plugging and sealing of pematted wells, monitoring
typed or printed in black or blue ink. Instructions
at term.
REPORT
and
Omer roes. rift form can be
and plugging standards are on
Well Permit
MH File
Number of the well being plugged
Number NH- Hole ID
or
*Name
812
Individual/Combanv rationed* for aura:end and sealino the well:
Narne(s)
m Add
City, st,
Phone (area
GODBE DRILLING LLC.
82802 OHLM ROAD
zip MONTROSE. CO, 81403
oode & no.) 970-240-6106 Email: 10dbetll01.00M
Well (Hole) Owner.
Phone (include area code) 305426-7752
NAME(S)
Melling Address,
GOLD HILL MINERALS
City, St, Zip PO BOX 191127, MIAMI BE.ACH.
FL, 33119-1127
ACTUAL WEU. LOCATION; Canty BOULDER
CL) 2 1 e >
Properly
?J1 1/4
Address, City, St, Zip 34 4cYa.. ON( tr Its
RA, Jet 1st e6fatted " i
of the .5 Sec. Z..4_, Twp. 2—
ga N. or
N. or C
0 S., Range 72. D E.
or Eil W.,
[3 W. Line.
6 441 PM.
Distance
Subdivision
Optional:
Format must
Eastlig
from Section Lines 2(33 Ft. from la
S. I, OV Ft. from WE. or
Lot Block , Filing/Unit
Name
GPS well location infomiation in UN format You Must check GPS unit for required settings as follows:
be UTM. zone 12 El or zone 13 ; Unit, must be meters; Datum must be NAD83; Unit rnust beset to true north,
445 LS 3 'I Northing iL, 44 i:
! (we) report
CI The well
0 The well
0111 Other
the existing well (hole) was plugged and sealed on
was plugged and sealed as required under Well Permit
was not in use and was plugged and sealed.
(please explain) CORE DRILL BORE HOLE ( ALL
the date of 09/10/2012 for
the following reason(s):
Number
CASINGS REMOVED)
The well was plugged with the following materials 13laced at the indicated intervals:
Amount and Type of Material Method of Placement Interval
265 GAL. DRILL CUTTINGS PUMP DOWN from 550 feet to 94' feet
6-50# SACS (HIGH SOLIDS BENTONITE) PUMP DOWN from 94' feet to icr feet
PORTLAI4D TYPE II CEMENT PLUG (111 10' AND BACKFILL froth 10' foot to 0' feet
Intervals of casing removedhipped In feet
from feet to feet
Report mat be signed or name entered by person who performed the well plugging work or by the well owner it this person is unknown or
not reachable. I (we) have read the statements made herein, know the contents thereof, and that they are hue to my (our) knowledge.
Sign or enter
full name
If signing print name & Me
BRIAN MANTEI GODBE DRILL FOREMAN
Date (mmiddlyyyyy)
09/10/2012
It Is the responsibility of the well owner to have
is responsible for notifying the owner of this requirement.
the well/hole properly plugged and sealed_ The Well Constructirm Contractor
Drill Logs: