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Form No. STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />GWS-09 , 821 Centennial Bldg.. 1313 Sherman St., Denver, CO 80203 <br />4t2012 (303) 886 -3581 Fax (303) 888-3589 dwroermitsonline®state co,us <br />WELL ABANDONMENT REPORT <br />Use to report plunging and sealing of permitted webs, monitoring and other toles, This form can be <br />computer generated. typed or printed in black or blue ink Instructions and plugging standards ere on <br />reverse side of form. <br />Well Permit Number of the well being plugged <br />MH FNe Number MH- Hole ID #1Name B12 - <br />IndividuaUComoanv responsible for oka9gina and sealing the well: <br />Name(s) GODBE DRILLING LLC. <br />mailing Address 62802 OHLM ROAD <br />City, St., zip MONTROSE. CO. 81403 <br />Phone (area code & no) 970 - 240.8106 Email: j)godbe@aoLcom <br />Wel (Hgle) Owner <br />NAME(S) GOLD HILL MINERALS Phone (include area code) 305-726 -7752 <br />Mating Address, City, St, Zip PO BOX 191127, MIAMI BEACH. FL. 33119 -1127 <br />ACTUAL WELL LOCATION; County BOULDER <br />Property Address, City, St, Zip 3G 4<5 � D ✓C r1aHd �. ` l ar+.l Cal SG14 <br />/Vf1/4 of they W 1/4, Sec. 2 . Twp. 2 1i1.N. or ❑ S., Range 7 - 2 — D E. or 81'i1 W. a-4 PM. <br />Distance from Section Lines 2,3 30 Ft. from fl N. or C S., Ir!>T) Ft from ®E. or 0 W. Line. <br />Subdivision Name Lot Block , Filing/Unit <br />Optional: GPS well IoCalion information in UTM format You must check GPS unit for required settings as follows: <br />Format must be UTM, zone 12n or zone 13 ®; Units must be meters: Datum must be NAD83; Unit must be set to true north <br />Easting 446; 331 Northing 4 441, 'r <br />1 (we) report the existing well (hole) was plugged and sealed on the date of 09/17/2012 <br />❑ The well was plugged and sealed as required under Well Permf Number <br />❑ The well was not in use and was plugged and sealed <br />MI Other (please explain) CORE DRILL BORE HOLE ( ALL CASINGS REMOVED) <br />The well Was plugged with the following materials placed at the indicated intervals: <br />Amount and Type of Material Method of Placement <br />330 GAL DRILL CUTTINGS PUMP DOWN <br />8-50# SACS (HIGH SOLIDS BENTONITE) <br />PORTLAND TYPE II CEMENT <br />Intervals of casing removedlripped In feet <br />Sign or enter full name <br />PUMP DOWN <br />if signing print name & title <br />for the following reason(s): <br />For Office Use Only <br />Interval <br />from 707 feet to 135 <br />from 135 feet to 10' <br />Date (mmfddlyyyyy) <br />BRIAN MANTEL GODBE DRILL FOREMAN 09/17/2012 <br />PLUG 10' AND BACKFILL from 10' feet to 0' feet <br />from feet to <br />Report must be signed or name entered by person who performed the well plugging work or by the well owner if this person is unknown or <br />not reachable I (we) have read the statements made herein, know the contents thereof, and that they are true to my (our) knowledge. <br />It is the responsibility of the well owner to have the well/hole properly plugged and sealed. The Well Construction Contractor <br />is responsible for notifying the owner of this requirement. <br />