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Individu tt ompanv responsible for plugging and sealing the wen: <br />Name(s) GODBE DRILLING LLC. <br />Msiseg Address 62802 OHLM ROAD <br />City, St -, zip MONTROSE, CO, 81403 <br />Phone (area code & no.) 970 - 240 -6106 Emil: jjgodbe@aol.com <br />Well (Hole) Owner <br />NAME(S) GOLD HILL MINERALS Phone (include area code) 305 726 - 7752 <br />tailing Address, City, St, Zip PO BOX 191127, MLAMI BEACH. FL, 33119 -1127 <br />ACTUAL WELL LOCATION: County BOULDER <br />Prope rty Address, City, St, Zip 3b ' S ? Qv er la�.d >7 es'f+srv,, ! Cd 8D Md"S <br />AW114 of the.3 W1/4, Sec. 2 e f t , Tap. 2 N. or ❑ S., Range 7. 0 E. or El W., � P.M. <br />Distance from Section Lines 03 Ft. from fl N. or C S., !Agin Ft from ►<• E. or p W. Line <br />Subdivision Name Lot Block , FningtUnit <br />Optional: GPS well location Information in UTM format. You must check GPS unit for required settings as follows: <br />Format must be UTM, zone 12 C7 or zone 13 P1 Units must be meters: Datum must be NAD83: Unit must be set to true north. <br />Easting $45 Northing 'T, #4 <br />I (we) report the existing well ( hole) was plugged and sealed on the date of 09/27/2012 for the folIowing reason(s): <br />❑ The well was plugged and sealed as required under Wel Permit Number <br />CJ The well was not in use and was plugged and sealed <br />m Other (please explain) CORE DRILL BORE HOLE ( ALL CASINGS REMOVED) <br />Font No. l STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />GWS 1 821 Centennial Bldg., 1313 Sherman St, Denver. CO 80203 <br />4/2012 1 (303) 866 -3581 Fax ( 303) 866-3589 dwr m ggiet c�state.co.us <br />v <br />WELL ABANDONMENT REPORT <br />Use to report t*Jggmg and sealing of permitted wets, monitoring and other holes This form can be <br />computer generated, typed or printed in black or blue ink. Instructions and plugging standards are on <br />reverse side of fon. <br />Well Permit Number of the well being plugged or <br />MH File Number MH- Hole ID Name 12 - <br />-- - - - - - - - - - - -- <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 />PUMP DOWN from 640 feet to 122 feet <br />PUMP DOWN from 122 feet to 10 feet <br />PLUG r 10' AND BACKFILL from 10 feet to 0 feet <br />306 GAL DRILL CUTTINGS <br />7 -50# SACS (HIGH SOLIDS BENTONITE) <br />PORTLAND TYPE II CEMENT <br />Intervals of casing removedlripped in feet <br />Report must be signed or name entered by person who performed the wet plugging work or by the well owner if this person is unknown or <br />not reachable. 1 (we) have read the statements made herein, know the contents thereof, and that they are true to my (our) knovriedge <br />Sign or enter full name <br />If signing print name & title Date (mm/ddlyyyyy) <br />BRIAN MANTEI GODBE DRILL FOREMAN 09/27/2012 <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 />For Office Use Only <br />from feet to feet <br />