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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 />4f2012 j (303) 866 -3581 Fax ( 303) 868 -3589 dvKt ermrtsonIineclstate_co.us <br />WELL ABANDONMENT REPORT <br />Use to report plugging and seating of permiited wills. monitoring and other holes. This form can be <br />computer generated, typed or pricked in black or blue ink. Instructions and plugging standards are on <br />reverse side of form <br />Well Permit Number of the well being plugged <br />MH File Number MH- Hole ID #!Name B12 <br />IndividuaUComoanv responsible for Pluswin a and dealing the well: <br />Na GODBE DRILLING LLC. <br />Mailing Address 62802 OHLM ROAD <br />City, St, Zip MONTROSE, CO, 81403 <br />Phone (area code & no) 970- 240 -6106 Email: lKaodbeaad.00m <br />WO (Hole) Owner. <br />NAMES) GOLD HILL MINERALS Phone (include area code) 305-726-7752 <br />Marling Address, Ctty, St., Zip PO BOX 191127, MIAMI BEACH, FL, 33119 - 1127 <br />ACTUAL WELL LOCATION: County � BOULDER d /- <br />Property Address, City, St, Zip . � Q 46'104 red TEES -1 'ai i Co ge <br />At 1/4 oftheJ 'J1/4, Sec. 24. Twp. 2 MN. or D S., Range 72... ©E or a w., ' P.M. <br />Distance from Section Linesai 334 Ft. from CI N. or I~ S. O Ft. from XE. or © W. Line. <br />Subdivision Name Lot Block . FiImg!Umt <br />Optional: GPS well location information in UTM format. You must check OPS unit for required settings as follows <br />Format must be UTM, zone 12 In or zone 13 Units must be meters: Datum must be NAD83; Unit must be set to true north. <br />Easfing ' �t�,s 3 .$ 9 Northing 4 4 44/, 2 1/1 <br />I (we) report the existing wed (hole) was plugged and sealed on the date of 09/23/2012 <br />o The well was plugged and sealed as required under Well Permit Number <br />0 The well was not in use and was plugged and sealed. <br />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 Interval <br />345 GAL. DRILL CUTTINGS PUMP DOWN from 747 feet to 154 feet <br />9-50# SACS (HIGH SOLIDS BENTONITE) PUMP DOWN from 154 feet to 10 feet <br />PORTLAND TYPE II CEMENT PLUG a 10' AND BACKFILL from 10 feet to 0 feet <br />Intervals of casing removed/ripped in feet <br />Report mug be signed or name entered by person who performed the well plugging work or by the well owner lithe person is unknown <br />not reachable. I (we) have read the statements made herein, know the contents thereof, and that they are tnie to my (our) knowledge. <br />Sign or enter full name <br />BRIAN MANTEL GODBE DRILL FOREMAN <br />for the following reason(s): <br />from feet to feet <br />If signing print name & title Date (mm/ddlyyyyy) <br />09/23/2012 <br />It is the responsibility of the well owner to have the wellhole properly plugged and sealed. The Wet Construction Contractor <br />is responsible for notifying the owner of this requirement <br />