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Form Appeved.OM8 No.2060-0042.Aoorovat exotres 4-30-91 <br /> UNITED STATES ENVIRONMENTAL PROTECTION AGENC%'- <br /> _� WASHINGTON.DC 20460 <br /> PA PLUGGING AND ABANDONMENT PLAN <br /> NAME AND ADDRESS OF FACILITY - -- - NAME AND ADDRESS OF OWNER/OPERATOR <br /> STATE COUNTY PERMIT NUMBER <br /> LOCATE WELL AND OUTLINE UNiT ON <br /> SECTION PLAT — 640 ACRES - �- <br /> SURFACE LOCATION.DESCRIPTION. : - <br /> N _ = 14 OF =1[OF :t.= -'A SECTION R:TOWNSHIP RANGE <br /> LOCATE WELLIN TWO DIRECTIONS FROM NEAREST LINES OF QUARTER SECTION AND DRILLING UNIT- <br /> -surl6as v, <br /> i I I i <br /> s ;zLoaRion_�1L(corm tN/s1 Lute d gwelar aaetlori <br /> and_R.from Lim of ouarter ' <br /> TYPE OF AUTHORIZATION WELL ACTIVITY <br /> D irtdividwl PermitO CLASS 1 <br /> W E 0 Area Permit O CLASS 11 <br /> ..0 Ruh.= .. _- _ C3 Brine Disposal__ <br /> E3 Enhanced Recovery <br /> Number of Wells 13 Hydrocarbon Storage <br /> O CLASS 111 <br /> S Leat a m ne WMA Numbs. <br /> CASING AND TUBING RECORD/rFTER PLUGGING METHOD OF EMPLACEMENT OF CEMENT PLUGS t' <br /> ❑The Balance Method <br /> cME WT(LB/Fi) TO BE PUT M WELL(M 0 BE LEFT 1N WELL(FT) HOLE SIZE ❑The Dump Beller Method <br /> ❑The Two-Plug Method <br /> �' ❑Other <br /> CEMENTING TO PLUG AND ABANDON DATA; PLUG M1 PLUG N2 PLUG N3 PLUG N4 PLUG 05 PLUG M6 PLUG N7 <br /> Site of Hole or.Pips in which Plug Will Be Placed(inches) <br /> Depth to Bottom of Tubing or Drill Pipe th.) <br /> Sacks of Cement To Be Used(each 04 <br /> Slurry Volume To Be Pumped(cu.h.) <br /> Calculated Top of Plug(ft.) <br /> Measured Top of Plug(if tagged h.l <br /> Slurry Wt.(Lb./Gal.) <br /> T- <br /> im Cement or Other Material Class 111) f <br /> UST ALL OPEN HOLE AND/OR PERFORATED INTERVALS AND INTERVALS WHERE CASING WILL BE VARIED iN enVj <br /> From To From To <br /> Estimated Cost to Plug Wells <br /> CERTIFICATION <br /> ' I certify under the penalty of law that I have personally examined and am familiar with the information <br /> submitted in this document and all attachments and that, based on my inquiry of those individuals <br /> immediately responsible for obtaining the information, l believe that the information is true, accurate, <br /> andcomplete.lam aware that there are significant penalties for submitting false information,including <br /> the possibility of fine and imprisonment. (Ref. 40 CFR 144.32) <br /> Ir <br />