API P-17,2493/1Form No. IOW

(1970) 640` Acres

N

Locate Well Correctlyand Outline Lease

5070Commenced Plugging imfi 4 —. _

County :>,‘

SEsk Sec. Twp Range

Location in Sectia2- ' 1/4 1/4MI

1/4

Farm Name "4 14 (11"Challin Well No 4 Field Raaa"

Character of Well (whether oil, gas or dry) Temporarily Abandoned

Finished 4.640 Total Depth 674'

Was permission obtained from the Corporation Commission or its agents before plugging was commenced Teo

Signature of District Manager Perforations-

Name of Field Supervisor SleekName of producing sand Warta"

PLUGG.-41G kt;tuttutOKLAHOMA CORPORATION COMMISSION

Oil ond Gas Conservation DivisionOklahoma City, Oklahoma

NOTICE; All questions on this form must be satisfactorily answeredand mailed to District Office in duplicate. Within 15 daysafter plugging is completed.

Browdar & Rataliff Company Operating

Office Address KO. Sem 579 Dewey Okla. 74029

wathingten 6 288 13S

Depth top 618 Bottom 65°

Show depth and thickness of all fresh water, oil and gas formations. Oklahoma Tax Commission Assigned Lease No

SAND OR ZONE RECORDS CASING RECORDS

Formation Content From To Si ze Put In Pulled Out

Wayside c:iand Oil 618 650 8 5/8 52

7 418

Describe in detail the manner in which the wel was plugged, indicating where the mud fluid was placed and the methods used in introducing it

into the hole. If cement or other plugs were used, state the character of same and depth placed:

Rem 6501 of 2" thbing and pumped in 10 saoks (tomcat. Pulled 7* easing, Ran 3701 ot 2"

and pumped in 5 seeks oement. Pulled tUbing te 75' mod pumped in 5 seek* *sant.

(Meld between Emmet plugs)

Does the above conform strictly to the oil and gas regulations?

The Law requires that adjacent lease, and land—owners be notified; give their names with their addresses below:

This well be re-opened at a later dste. It i* just temporarily dbandoned•

REMARKS: Why plugged? If abandoned oil or gas well, state amount and date of last production

Plugging Contractor's Name• Address.

Correspondence regarding this well should be addressed to 6rewder & Roteliff P.O. Rex 579 Dewey Okla. 74029

Address

I, the undersigned, being duly sworn upon oath, state that this well record is true, correctoffice and to the best of my knowledge and belief.

Subscribed and sworn to before me this the

il

i

Alele'and title of representative of companyFa

e e according to the records of this

day of , 19

Commission expires Notary Public