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Form No � STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />OWS-09 + 821 Centennial Bldg., 1313 Sherman St., Denver, CO 80203 <br />4/2012 (303) 888 -3581 Fax (303) 888 -3589 dwrpermitsontineftstate.co us <br />WELL. ABANDONMENT REPORT <br />use to report plugging and sealing of permitted wells, monitoring and other hies. This form can be <br />computer generated, typed or printed in black or due ink Instructions and plugging standards are on <br />reverse side of torn. <br />Well Permit Number of the well being plugged or <br />MR FNe Number MN- Hole ID #INeme 012 -6 <br />Individual/Company responsible for plugging and sealing the wet: <br />Name(s) GODBE DRILLING LLC. <br />Mating Address 82802 OHLM ROAD <br />City, St, Zip MONTROSE, CO, 81403 <br />Phone (area code & no.) 970-240-6106 Ema1: itaodbeiaaolcom <br />Well /Hob) Owner: <br />NAME(S) GOLD HILL MINERALS Phone (include area code) 305-726 -7752 <br />Malirg Address, City, St, zip PO BOX 191127, MIAMI BEACH, FL, 33119 <br />ACTUAL WELL LOCATION; County BOULDER <br />Property Address, City, St, Zip M0 4 rA Dv er la 4 k , 3a wtesteivrt C) Al *SS <br />NE l /4 of the ...5V1/4 Sec. 2 - Twp 2- ® N or © S , Range 7 2 ® E. or EL W , G 2 :is P.M. <br />Distance from Section Lines 2 r33i9 Ft. from (RI N or C S., P&P R. from 51g. or 0 W. Line. <br />Subdivision Name Lot , Block FIling/Unt <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 12n or zone 13 "� ; �' Units must be meters; Datum must be NAD83; Und must be set b true north. <br />Fasting 44g —c 3.3 Q North ing 45 t j 3fiti <br />I (we) report the existing well (hole) was plugged and sealed on the date of 09130/2012 for the following reason(s): <br />❑ The well was plugged and sealed as required under Well Permit Number <br />❑ 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 enervate: <br />Amount and Type of Material Method of Placement Interval <br />280 GAL. DRILL CUTTINGS PUMP DOWN from 607 feet to 122 feet <br />7-50# SACS (HIGH SOLIDS BENTONITE) PUMP DOWN from 122 feet to 10 feet <br />PORTLAND TYPE II CEMENT PLUG CO 10' AND BACKFILL from 10 feet to 0 feet <br />Intervals of casing removed/ripped In feet from <br />Report mugt be sgned 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 />Sign or enter full name If signing pnnt name & title <br />BRIAN MANTEI GODBE DRILL FOREMAN <br />tt 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 />T For Office Use Only <br />feet to <br />Data (mmk1WYyyyy) <br />09/30/2012 <br />