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Home My WebLink About20194103.tiff SRC ENERGY Att 1261 y March 12, 2019 Director Colorado Oil and Gas Conservation Commission 1120 Lincoln Street, Suite 801 Denver, CO 80203 RE : COGCC Rule 502. b Variance Request for 1001. c Surface Owner Waiver Well Name : Sam F 11-9 API It : 05-123-26602 Location ID : 310570 Facility ID : 293730 Township 5 North, Range 65 West, 6th P. M ., Section 11, NESE Weld County, Colorado Dear Director , SRC Energy, Inc. (SRC) has obtained a Surface Owner Waiver under Rule 1001 . c for final reclamation of the former Sam F 11-9 well pad, production pad, and associated access road ( Location ID : 310570) . SRC has performed final reclamation on this location in accordance with the surface owner' s request . Due to the surface owner's final reclamation requests of the location, we are requesting your approval for a variance from the requirements of Rule 1004 . d . The documents attached to this letter for the former Sam F 11-9 well pad, production pad, and associated access road were developed in accordance with the December 17, 2015, version of the COGCC Rule 1001 . c : Reclamation Variances and Waivers guidance document ( Guidance Document) . Attachment A : Executed Final Reclamation Agreement Attachment A is a signed and executed agreement that SRC has entered with the surface owner regarding topsoil protection and reclamation . Attachment A fulfills the five ( 5 ) requirements listed in Section I of the Guidance Document . Attachment R. Operator Demonstration Attachment B, along with all figures and Exhibits 1, 2 and 3, fulfills the eight (8 ) requirements of Section II . B in the Guidance Document to waive compliance with specified provisions of Rule 1004, via a Variance . Attachment B contains the required supporting documentation to demonstrate that granting this final reclamation variance for applicable requirements of Rule 1004 will not negatively impact public health, public safety, public welfare, the environment, or wildlife . SRC has made a good faith effort to provide the necessary information and evidence requested in the December 17, 2015, version of the COGCC Rule 1001 . c : Reclamation Variances and '614Sitsetth & eiY/s ) j2019-4103 a 2O0q 5400 W. 11th St. Suite C Greeley, CO 80634 970A75 . 5220 970.475. 5221 (fax) 9— / if; I oaai Waivers guidance document for the Director to evaluate our request for waiving specified provisions of Rule 1004 to fulfill the surface owner' s request for final reclamation . If you have any questions or concerns about SRC' s variance request, please do not hesitate to contact me at mjones@srcenergy. com Sincerely,/ / i /...,- 7 4:0:7447 / 7 "1St_ 4.1 Matt Jones 7 Landman II ' _ ^ SRC Energy, Inc. Attachments : Attachment A: Executed Final Reclamation Agreement Attachment B : Operator Demonstration Exhibit 1 : Facility Photos and Aerial Map Exhibit 2 : Approved Well Abandonment — Subsequent Form 6 Exhibit 3 : Reclamation Consultation Form 2 Attachment A SRC ENERGY a rAfr April 9, 2019 RE : Executed Final Reclamation Agreement Well Name : Sam F 11-9 API it : 05- 123-26602 Location ID : 310570 Facility ID : 293730 Township 5 North, Range 65 West, 6th P. M ,, Section 11, NESE Weld County, Colorado Mrs . Barbara Kirkmeyer, SRC Energy Inc . (SRC) has previously consulted with you concerning final reclamation for the Sam F 11-9 well pad, production pad, and associated access road ( Location ID : 310570 ) in accordance with your team 's direction concerning future use of the land and applicable rules of the Colorado Oil and Gas Conservation Commission ( "COGCC" ) . The well was plugged and abandoned in September 2018 and SRC has removed all associated well and production facility equipment from the site . Pursuant to COGCC Rule 1001 . c, SRC and the Surface Owner, agree to enter into this Final Reclamation Agreement to set forth the respective rights and responsibilities of the parties, and to seek COGCC' s waiver of compliance with certain 1000- series rules . For the specific portion of the oil and gas location see attached map labeled as Exhibit A (the " Location" ) , subject to this Final Reclamation Agreement and waiver include : • Associated well pad, production pad, and respective access road within the Weld County operational area . The reasons for Surface Owner entering into this Final Reclamation Agreement and thereby waiving SRC' s obligations for additional reclamation required under COGCC Rule 1004 at the Location include : • Oil and Gas operations for SRC Energy were on Weld County active trucking operations . Weld County has plans to use this area for maintenance and storage . • The location is within Weld County' s stormwater permit boundaries . • Weld County will accept responsibility for weed control . As the Surface Owner, you acknowledge that the current condition of the property subject to this Final Reclamation Agreement and is satisfactory to you . If applicable, you acknowledge responsibility of topsoil protection . Additionally, by executing this letter below, as the Surface Owner, you also acknowledge that you knowingly, and forever, waive all reclamation protections otherwise afforded by COGCC Rule 1004 and that you will assume responsibility 5400 W. 11th St. Suite C * Greeley, CO 80634 * 970.475 . 5220 * 970.475. 5221 (fax) for any further reclamation activities you wish to have undertaken at this site . Provided however, SRC must comply with all final reclamation requirements under the Rule 1000-series that may not be waived by the Surface Owner including COGCC Rule 1004. c. (4-5 ) . If this Final Reclamation Agreement correctly reflects your agreement, please sign and date this letter, keep a copy for yourself and return one to the undersigned . Please be aware that although you have signed this Final Reclamation Agreement and SRC subsequently submits a reclamation variance request, the COGCC may deny such request and SRC will then be required to complete all final reclamation in accordance with the COGCC 1000 Series rules . SRC is responsible for surface stabilization, stormwater management, and weed control until the variance request is approved . Thank you for your time and consideration in this manner. If you have any questions or comments, please contact me at mjones@srcenergy. com . Sincerely,: //" ././ rr , rs Matt Jones 7 Landman II SRC Energy Inc. Attachments : Attachment B : Operator Demonstration Exhibit 1 : Facility Photos and Aerial Map Exhibit 2 : Approved Well Abandonment — Subsequent Form 6 Exhibit 3 : Reclamation Consultation Form ACCEPTED AND AGREED : SURFACE OWNER Weld County Barbara Kirkmeyer, Chair, Board of Weld County Commissioners Date : SEP 5 71 , 19 / Date : 2 °t o / 9 , 4/ 03 Attachment B l Y.: = SRC ENERGY March 12, 2019 RE : Operator Demonstration : Well Pad, Production Pad, and Access Point Well Name : Sam F 11-9 API # : 05- 123-26602 Location ID : 310570 Facility ID : 293730 Township 5 North, Range 65 West, 6th P . M ., Section 11, NESE Weld County, Colorado The information below addresses the requirements detailed in Section II . B of the Colorado Oil and Gas Conservation Commission ' s ( COGCC) Rule 1001 . c : Reclamation Variances and Waivers guidance document ( Guidance Document) dated December 17, 2015 . Section II . B of the Guidance Document outlines the evaluation of whether public health, safety, and welfare are protected and how significant adverse environmental impacts are prevented if specified provisions of Rule 1004 is waived, via a Variance . Section II . B. 1 - Evidence that all wells on the location have been Plugged and Abandoned ( P&A) and that a Form 6 subsequent was submitted for each well . SRC Energy Inc. (SRC) certifies that the former Sam F 11-9 wellhead (API : 05- 123 -26602, Location ID : 310570) has been P &A and the Form 6 subsequent has been submitted ( Document Number : 401759703 ) . Section II . B . 2 — Evidence that all oil and gas equipment has been removed, including flowline and gathering risers. SRC certifies that all oil and gas equipment, including flowline and gathering risers, has been removed from the former Sam F 11-9 well pad , production pad , and access road where the final reclamation variance is being requested . Exhibit 1 consists of facility photos taken on March 11, 2019, that demonstrate all equipment has been removed . Section II . B. 3 — Evidence that all trash and debris belonging to the operator or its agents has been removed . SRC certifies that all trash and debris belonging to SRC or any of our contractors or agents has been removed from the former Sam F 11-9 well pad, production pad , and access road where the final reclamation variance is being requested . Exhibit 1 consists of facility photos taken on March 11, 2019, that demonstrate all trash and debris has been removed . 5400 W . 1. 1th St. Suite C * Greeley, CO 80634 * 970.475 . 5220 * 970.475 . 5221 (fax) Section II.B.4—Evidence that noxious weeds have been controlled as required by Rule 1004. SRC certifies that weeds, noxious and non-noxious, have been controlled and/or removed from the former Sam F 11-9 well pad, production pad, and access road (Location ID: 310570) and will be managed by SRC until approval of this final reclamation variance. Exhibit 1 consists of facility photos taken on March 11, 2019,that demonstrate weed control on the location. Section II.B.5 — Documentation of Good Faith Surface Owner Consultation regarding final reclamation pursuant to Rule 306.f. Attachment A provides the Letter to the Surface Owner for the Sam F 11-9 well pad, production pad, and access road (Location ID: 310570) documenting good faith consultation with the surface owner. Section II.B.6—Documentation of existing state of reclamation. SRC certifies that the former Sam F 11-9 well pad, production pad, and access road have been reclaimed in accordance with the request of the Surface Owner (see Attachment A—Letter to the Surface Owner). The Surface Owner has requested that the former well pad and production pad be left as-is. Exhibit 1 consists of facility photos taken on March 11, 2019, that demonstrate the existing state of reclamation. Section II.B.7 — Evidence that site is stabilized, and stormwater management is adequate pending COGCC's final sign-off reclamation inspection. SRC certifies that the former Sam F 11-9 well pad, production pad, and access road are stabilized, and permanent stormwater management is adequate. All installed erosion control devices (ECDs) are in proper working condition as of the date of this submittal. SRC also certifies that SRC will maintain the location to ensure proper stabilization and stormwater management until this variance is approved and all condition of approvals fulfilled. Exhibit 1 consists of facility photos taken on March 11, 2019, that demonstrate proper stabilization and permanent stormwater management controls, which consists of access road and production pad surfacing using Class 5 road base material. Section II.B.8 — Operator analysis of protection of public health, safety, and welfare; and prevention of significant adverse environmental impacts. SRC has determined that granting this final reclamation variance to Rule 1004 (except Rules 1004.c.(4) and 1004.c.(5), for which compliance will continue to be required), would not negatively impact public health, public safety, public welfare, the environment, or wildlife. Based on the explanation below, SRC has determined that variance from compliance with the specific sections of Rule 1004 for the Sam F 11-9 well pad (API:05-123-26602), production pad, and access road (Location ID: 310570) would have NO NEGATIVE IMPACTS on public health, public safety, public welfare, environment,or wildlife. 2 Public Health Analysis The specified final reclamation variances requested from Rule 1004 are minor requests that maintain protection of public health. The location is on private property and, according to the "Surface Owners" COGCC GIS mapping layer, does not require any consultations with the Colorado Department of Public Health and Environment (CDPHE) or Colorado's Division of Water Resources (DWR). Public Safety Analysis The specified final reclamation variances requested from Rule 1004 are minor requests that maintain protection of public safety. The location is a small parcel of land (approximately 0.65 acres) located in a rural area. The location is currently topographically flat, and the request is to keep the land topographically flat. The original well pad, production pad, and access road have been left as-is. Public Welfare Analysis The specified final reclamation variances requested from Rule 1004 are minor requests that maintain the protection of public welfare. The enhanced construction of the location directly benefits the surface owner by adding economic value and utility to their property. The variance will add value as a location that will be developed for commercial development. 3 Environment The former Sam F 11-9 well pad does not fall within an internal buffer Public Water System Protection Area ( Rule 13B Table 1) according to the COGCC GIS " PWS 317B" mapping layer. The location is approximately 630 feet southeast of the nearest surface water according to several COGCC GIS "Water Resources" mapping layers ( Figure 1 ) . Due to the nature of this Reclamation Variance, the former Sam F 11-9 well pad and production pad location does not pose a threw_ to surface water. 11 -9 SAM F r a € t , Fi r k i s 0 125 250 _500 150 N-1000 Feet S "* Well Location Scum F 11 -9 Well Pad ' -- j Nearest Surface Water Feature 4COLORADO Location . - 630 Feet away 40,. � � E'cr�.tai°' rdearest Surface Water Feature � -�� ;gin „; .t, Figure 1. Distance to nearest surface water feature for the former Sam F 11-9 Well Pad . 4 The former Sam F 11-9 well pad is not within a wetlands area and did not require any U . S. Army Corps of Engineers ( USACE ) Section 404 permit . 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(/ '• / '� /r 1 /.f /A r+(,'/f . . / //' r d' #,Jd/d 8/ /r .A'� rdr A`d P /'/ d' f sj/'/ / f4 /d /' r ''/ •. !° r / ( ( /• " • r .7. / r ,r d•• / ..... /nF r d ,` / r,./F l Fr' JF. ! .✓•rt r /•+r • /f.. / . • . _ .f'f / a'�"r! r a i•' /t!/.' .r.d.o�' .�'r Bd�lX/ .,r. //.(./A e' / //../.."v dR/,/''I6 - WellLocation Sam F 11 -9 Well Pad COLORADO f..7-7--.7%� t i o n -- 92 Feet t away CO. 4R��?'�+tS�,'4RflerY«P:1C� SPEC ei.c°` Nearest identified FkoadplaEn� �� Yt�-7��, ,.y,r.• . , , . Figure 2 . Distance to nearest 100-Year floodplain for the former Sam F 11-9 Well Pad. 5 The location is approximately 1, 103 feet southeast of the nearest groundwater well, according to COGCC GIS "DWR Wells" mapping layer, which is based on Colorado' s DWR information ( Figure 3 ) 0 N N O N 11 -9 SAMF r A I, a !' Y `' rk' { 0 125 250 500 750 1.000 1so.,. Ns Feet S f '�(( �c�tion Sam F 11 -9 Well Pad COLORADO 0rwaterLocation . �- 1� 03 Feet away co y . . Nearest Ground ^cm:ru do n;erva frn. 4 5�'tC . �'��E(fS ttanic fon Figure 3. Distance to nearest groundwater well for the former Sam F 11-9 Well Pad. 6 Wildlife The former Sam F 11-9 well pad and production pad is not within a defined " Restricted Surface Occupancy" ( RSO) or "Sensitive Wildlife Habitat" (SWH ) area as identified in the COGCC GIS "CPW_RSO" and "CPW_SWH " mapping layers ( Figure 4 ) . The nearest defined RSO area is 3, 667 feet to the southwest . '$ `k 11 -9 SAM F 7' L 18 h St r l'Y; r .nroi °t i/,4c''pC` Y.t " x . Y''zb��nJb'1Y! s". . o }�,afro�0o �1 ,�p'a w:rq��jr�<Y� aX 'ry off, �4 S1,4 cro 'v� �q� ' N �R Wry 1 f�r,�,n�1r t r\ a' xf'' x '. [� fr,"44 '" e, .��4' �^ J, (y ��t� ro Tx i '(,N' l;, �y r o QAy�G'� .R{r2 e>��(( �ra� ibt+r ^ W e k g YH arc � r � 4404 '��„w ,(� 5i .< ' 8� , 3��2 " F l c 3 at t4 .+ + r 0 9�`b�� ^w� ) l�f'"4 " .ex'Xxa= +�� 'R�a66 rar�xon > n i�wy ,fie ≤'G { 4 ; 4i ro .� n14 a, ;are c. Mt 1 ��r=%� qq"� 0 250 590 1 .000 1 ,500 2.000 a yy. ra e ry� �� sy �,¢F R �r'`�x x�QD ^ A• ,, EariMENCIMMI @@t )Y s"zfell Location n Nearest �� Sam F 11 -9 Well Pad ,n� <alSatr COLORADO W„ Location . --- 3 , 667 Feet awayrr 3 �� anagnxat x. $PEC Nearest Amnon Fiurr-r 4. Distance to nearest Restricted Surface Occupancy ( ISO) oar Sensitive Wildlif - Habitat (SWH) f* r the f .: rmer Sam F 11-9 Well Pad . Based on this evaluation it has been established that : t.0 given the small size of the location; the nature of the variance; the surface owner's plans for the location ; and the fact that the location is on private property; granting this final reclamation variance for the Sam F 11-9 well pad, production pad, and access road (Location ID : 310570) would have NO NEGATIVE IMPACTS on public health, public safety, public welfare, the environment, or wildlife . 7 00 aF Au _,. Alta t SRC ENERGY ,, ,, 4 fa , sk As t ,), k r`' { 2019 Well Pad , Production Pad , and Access Road Rcclamation Variance Documentation „/ , ,, ,- . k `� '' � � /eWell Name : Sam F 11 - 9 Well Pad and � Sri; � = Production Pad au ,-- / 7 , cc; :r ENVIRONMENTAL CON8LILTING \ P 1 : 05 - 123 - 26602 " '' Location I D : 310570 " a , Facility ID : 293730 Prepared for : SRC Energy Inc . Prepared by : Duraroot, LLC Date : March 2019 Exhibit 1: Facility Photos and Aerial Imagery Exhibit 1 . FACILITY PHOTOS A) ,j.i.t_ SRC ENERGY ti $ Air a PREPARED FOR : SRC ENERGY INC . Facility : Sam F 11-9 COGCC Location ID# : 310570 Facility Type : Production Pad County: Weld Legal Description : NESE SEC11 T5N R65W Date Prepared : March 12, 2019 Date of Assessment : March 11, 2019 9 A. iie L. el 14 I �- , - 1,. ._ .- . ♦ ,!�►f. •.wwa - fir.sa,L.: --Y..,.....a _ _ - i: :!!s C�C lber tt s4 H6 j - .• .i!`rA bi..� .`' .T •.r• ai .3F r .6.: s� .� �•• ^ 1� '' , "Ise Y 1 •.• � 1r I' oar 4 .r� . t '• •- :-r N 41'. . J{ ,. • ••• L. a 4 • 4,. . • ..• • ' . -I* ' .". •• 4rai - ~� �'w• 0, . , , r + to•li _ am4t - I ♦ �a.. • Photo 1 . Sam F 11-9 Photo 2 . Sam F 11 -9 Location : 40.413677, - 104.622704 Location : 40.413952, - 104 .622627 Cardinal Direction : North Cardinal Direction : Southwest f Ail `sor_'!� --:J,. ij Y Yy.,,.a.. ..CA j � -' � „� (�� mod. p' •0 ...,►! Maw . - - - ' _ •.._,.. , ♦. !.. . - ..�., 1••'} _t. . \` 1' .�r �...j1. ,.4'�• •_• .�i'4`a liYy�1`Ltr'. di",_ -. . .' 4 •f.Fs�' �V - , i.'_. �'V.-� 11Y �' ♦ ••• sly • . 1N •3 4. ,f • , .. . . • T - �• 4. • „3(•u nM 'J J11d . f `t• ♦ K ' -' r•I i 1( .'.t• . 3 "ra� J , .F+ 'fit 1..41.• ' �•� • • l a. _ StN• l �Sjf -.,' !... fit,. .e - t a iee bl.t /�,^7 7J''" -t• 41 • Photo 3 . Sam F 11-9 Photo 4. Sam F 11-9 Location : 40.413860, - 104.622246 Location : 40.413807, - 104. 622894 Cardinal Direction : West Cardinal Direction : East 5400 W. 11th St. Suite C * Greeley, CO 80634 * 970 . 475 . 5220 * 970 . 475 . 5221 (fax ) ...014,...Exhibit 1 : FACILITY PHOTOS SRC ENERGY iitv ii ip PREPARED FOR : SRC ENERGY INC . 2h1 Facility : Sam F 11 -9 COGCC Location ID# : 310570 Facility Type : Production and Welt Pad County : Weld Legal Description : NESE SEC11 T5N R65W Date Prepared : March 12 , 2019 Date of Assessment : March 11 , 2019 'er , i C' 1 p '.urP.weas'-. .w �y.�� MM1A.pµ., 1'.1 4 IC , a i n y3. 4 i .$iblf ... ,. S '11$014,L r , WW6t?r:,JY �a. 1 s "3.₹�;^>�V., `4 -a I i • ...._� --._-v-ter,=-T;..- Photo 5 . Sam F 11-9 Photo 6. Sam F 11 -9 Location : 40. 413578, - 104 . 622437 Location : 40. 413631 , - 104 . 622475 Cardinal Direction : Northeast Cardinal Direction : Southeast S . 1 + �1n• N.. __ gg�� -J}.....NY ......R'- Photo 7 . Sam F 11 -9 Photo 8 . Sam F 11 -9 Location : 40 . 11888, 104 . 622513 Location : 40. 11888, - 104 . 622513 Cardinal Direction : East Cardinal Direction : West 5400 W . 11th St . Suite C * Greeley, CO 80634 * 970 . 475 . 5220 * 970 . 475 . 5221 (fax ) AS SRC ENERGY k ,, ip ,-; Exhibit 1 — Common source imagery of the former Sam F 11-9 Well Pad and Production Pad '- .ter tr- .. 'r'i _ . p'. 1 1 -9 Production Pa • 41. 4;4 40 • t a q .3 _ __. 3 r I a A ( t / _ Iil � /J .s i` f• t ; -i • - ltd �,.z '' I,. v t , „ it It NII•1' / iiir II ' .... , s. ...- m F 11 -9 Well Pad fir • , • ' j ` J t illalCiej • 01 ,4 . \ Ce SI, 1 1 Ntkl ha 1 2018 Coe, '_ C 4 Goo Earth E-13th-St 58 le s 1999 -- "' Imagery Date: 9/12/2015 40°24'44.23" U' Y04°3727.41 ¶27 @ ft ei a a.' 2211 `1 Aerial Imagery courtesy Google Earth 5400 W. 11th St . Suite C * Greeley, CO 80634 * 970. 475 . 5220 * 970 . 475 . 5221 (fax) Exhibit 2: Approved Well Abandonment - Subsequent Form 6 FORM State of Colorado D N R DE ET OE ES 6 oil and Gas Conservation Commission ° ` Document Number: Rev 1120 Lincoln Street, Suite 801 , Denver, Colorado 80203 Phone: (303) 894-2100 Fax: (303) 894-2109 .. 05/18Cv II tv I WELL ABANDONMENT REPORT TM 401759703 This form is to be submitted as an Intent to Abandon whenever an abandonment is planned on a borehole. After the abandonment is complete, this Date Received : form shall again be submitted as a Subsequent Report of the actual work completed. The approved intent shall be valid for six months after the approval date, after that period, a new intent will be required . Attachments required with the Intent to Abandon are wellbore diagrams of the current configuration and the proposed configuration with plugs set. 09/11 /2018 A Subsequent Report of Abandonment shall indicate the actual work completed. Attachments required with a Subsequent Report are a wellbore diagram showing plugs that were set and casing remaining in the hole, the job summaries from all plugging contractors used, including wireline and cementing (third party verification) and any logs that may have been run during abandonment. OGCC Operator Number: 10311 Contact Name : Monica Patel Name of Operator: SRC ENERGY INC Phone : (720) 616 .4300 Address : 1675 BROADWAY SUITE 2600 Fax: (720 ) 616 .4301 City: DENVER State : CO Zip: 80202 Email : mpatel@srcenergy. com For " Intent" 24 hour notice required , Name: Tel : COGCC contact: Email : API Number 05- 123-26602-00 Well Name: SAM F Well Number: 11 -9 Location : QtrQtr: NESE Section : 11 Township : 5N Range : 65W Meridian : 6 County: WELD Federal , Indian or State Lease Number: Field Name : WATTENBERG Field Number: 90750 Notice of Intent to Abandon IR Subsequent Report of Abandonment Only Complete the Following Background Information for Intent to Abandon Latitude: 40 .411858 Longitude : - 104 . 622903 GPS Data : Date of Measurement: 08/08/2008 PDOP Reading : 2 . 5 GPS Instrument Operator's Name : PAUL TAFFY Reason for Abandonment: Dry Production Sub-economic Mechanical Problems Other Casing to be pulled : Yes T No Estimated Depth : Fish in Hole : Yes f. No If yes , explain details below Wellbore has Uncemented Casing leaks: Yes No If yes , explain details below Details: Current and Previously Abandoned Zones Formation Perf. Top Pert Btm Abandoned Date Method of Isolation Plug Depth CODELL 6934 6948 08/07/2018 B PLUG CEMENT TOP 6560 NIOBRARA 6638 6768 08/07/2018 B PLUG CEMENT TOP 6560 Total : 2 zone(s) Casing History Casing Type Size of Hole Size of Casing Weight Per Foot Setting Depth Sacks Cement Cement Bot Cement Top Status I , SURF 12+ 1 /4 8 +5/8 24 484 272 484 0 VISU S U 1ST 7+7/8 4+ 1 /21 11 .6 7 , 075 1 , 040 7 , 091 1 , 269 CBL - Date Run: 12/12/2018 Doc [#401759703] Well Name: SAM F 11-9 Page 1 of 3 Plugging Procedure for Intent and Subsequent Report CIBP #1 : Depth 6560 with 15 sacks cmt on top . CIPB #2 : Depth 2400 with 2 sacks cmt on top . CIBP #3 : Depth with sacks cmt on top. CIPB #4 : Depth with sacks cmt on top . CIBP #5 : Depth with sacks cmt on top . NOTE : Two(2 ) sacks cement required on all CIBPs . Set 15 sks cmt from 6560 ft. to 6362 ft. Plug Type : CASING Plug Tagged : F Set sks cmt from ft. to ft. Plug Type : Plug Tagged : F Set sks cmt from ft. to ft. Plug Type : Plug Tagged : In" Set sks cmt from ft. to ft. Plug Type : Plug Tagged : Set sks cmt from ft. to ft. Plug Type : Plug Tagged : Perforate and squeeze at ft. with sacks. Leave at least 100 ft. in casing CICR Depth Perforate and squeeze at ft. with sacks . Leave at least 100 ft. in casing CICR Depth Perforate and squeeze at ft. with sacks . Leave at least 100 ft. in casing CICR Depth (Cast Iron Cement Retainer Depth) Set 160 sacks half in . half out surface casing from 776 ft. to 0 ft. Plug Tagged : Set sacks at surface Cut four feet below ground level , weld on plate Above Ground Dry- Hole Marker: Yes No Set sacks in rat hole Set sacks in mouse hole Additional Plugging Information for Subsequent Report Only Casing Recovered : 726 ft. 4+ 1 /2 inch casing Plugging Date : 08/16/2018 of *Wireline Contractor: SPN Well Services *Cementing Contractor: Cementer's Well Service , Inc. Type of Cement and Additives Used : 15. 8# class g neat Flowline/Pipeline has been abandoned per Rule 1105 f Yes No *ATTACH JOB SUMMARY Technical Detail/Comments : I hereby certify all statements made in this form are , to the best of my knowledge, true , correct, and complete . Signed : Print Name : Christi Ng Title : Sr. Regulatory Analyst Date : 9/11 /2018 Email : cng@srcenergy.com Based on the information provided herein , this Well Abandonment Report (Form 6 ) complies with COGCC Rules and applicable orders and is hereby approved . COGCC Approved : Strathman , Elliot Date : 12/12/2018 CONDITIONS OF APPROVAL, IF ANY : COA Type Description Date Run: 12/12/2018 Doc [#01759703) Well Name: SAM F 11-9 Page 2 of 3 Attachment Check List Att Doc Num Name 401759703 FORM 6 SUBSEQUENT SUBMITTED 401759722 OPERATIONS SUMMARY 401759734 GYRO SURVEY 401759740 LOCATION PHOTO 401759743 WELLBORE DIAGRAM Total Attach: 5 Files General Comments User Group Comment Comment Date Stamp Upon Approval Total: 0 comment(s) Date Run: 12/12/2018 Doc(#401759703)Well Name:SAM F 11-9 Page 3 of 3 Exhibit 3: Reclamation Consultation Form ocit (--)L' vt-e5 rvij on€5 es rt en erffy atm a SRC Energy SRC ENERGY • 5400 West 11th Street, Suite C, Greeley, CO 8O634 - ' + x �; Tel 970.475-5220 Fax 97G-475-5221 FINAL RECLAMATION CONSULTATION FORM PURSUANT T O COGCC RULE 306,1 WELL OR PAD NAME : yeti F ( t - (7 ? Townsi ip._...., ..,_.., ..... ....._. Range . . . . Section �.� QTR./`QTR.. Variance Requested: YES ' " RECLAMATION OF WELL PAD YES NO Leave pad flat with gravel (As is) Leave pad flat and re-seed Reclaim pad to original contours and re-seed Other: �` � _ t.€ #4-71o,4 J - recycled c.t. .s.i jet,. -1 RECLAMATION OF PRODUCTION PAD YES NO _._.._. ._...�..lreave pad flat with gravel (As is) � .� .� S. A . - . ID trig..dj Leave pad flat and re-seed Reclaim pad to original contours and re-seed Other RECLAMATION OF ACCESS ROAD c.... ..,.:..... ,. Ate. ....p ..... w ......_ .1`� ...V' .. .. YES NO I f ! � � Leave original access road with gravel (As is) . . .,,�._.�.Y.�..._,..w...T..... �.� ..�..�.�....�,�.�._r..Mw..,_...m�._....._._....,...... -- Leave road flat and re-seed Reclaim access roads to original contours and re-seed ( Other: WORK TO BE COMP ETED BY SURFACE OWN B/TFNANT YES NO Surface Owner and/or Surface Tenant requests to personally complete all necessary reclamation work Other: . ) . COMMENTS/OTHER 7Represented y ' ..- .. t.... rte, ._._ (sign) `r�' ' �` (print) Discussed ' . day of. 20,49 NOTE: THIS FORM IS FOR THE PURPOSE OF OBTAINING SURFACE OWNER/TENANT REQUESTS REGARDING THE MATTERS SET FORTH ABOVE AND EXECUTION OF THIS FORM IS NOT INTENDED TO CREATE A BINDING AGREEMENT. ALL REQUESTS ARE SUBJECT TO OPERATOR AND COGCC APPROVAL AND IN ACCORDANCE WITI-I ALL GOVERNMENT REGULATIONS IN EFFECT. IF A VARIANCE IS REQUESTED BY THE SURFACE OWNER/TEN.ANT, THIS FORM WILL BE SUBMITTED TO COGCC IN ACCORDANCE WITH COGCC RULE 1001.c, AS STATED IN THE DECEMBER 2015 RULE l0O1.c COGCC OPERATOR GUIDANCE UNDER SECTION !LBO). OPERATOR IS Noir RESPONSIBLE FOR MAINTENANCE ON WELL PADS OR ACCESS ROADS LEFT IN "AS IS" CONDITION Sur ce OwnerfTena ignature Barbara Kirkmeyer , Chair , Board ,t (sign) of Weld County Commissioners (print) 4 , 1 (sign) __. ( print) Owner's Address: 11150 0 Street . Greeley1 CO S.Q6�I Phone _. 970) 400-4200 MS-1 S NOT A BINDING AGREEMENT 2019-0274 Esther Gesick Subject: FW: Reclamation Variance: Sam F 11 -9 Attachments: FW: Reclamation Variance: Sam F 11 - 9 From : Toby Taylor <ttaylor@weldgov . com > Sent : Thursday, September 12 , 2019 7 : 13 AM To : Esther Gesick <egesick@weldgov . com > Cc : Cheryl Hoffman < choffman@weldgov . com > Subject : RE : Reclamation Variance : Sam F 11 -9 Esther, I have finally had some time to look into this one . Per the attached e-mail that I had in my file, it appears you guys were just going to add this to consent and reference the original Tyler # . If you need something different, just let me know . Toby Taylor, Director Weld County Department of Buildings & Grounds Weld County Veterans Services 1105 H Street P . O . Box 758 Greeley, CO 80632 P : 970 .400 . 2023 F : 970 . 304 . 6532 ttaylor@weldgov . com From : Esther Gesick <egesick@weldgov . com > Sent : Thursday, September 05, 2019 11 : 29 AM To : Toby Taylor <ttaylor@weldgov . com > Cc : Esther Gesick <egesick@weldgov . com >; Cheryl Hoffman <choffman@weldgov . com > Subject : FW : Reclamation Variance : Sam F 11-9 Hi Toby, I wanted to give you a few days to follow up on this since you were out all last week . When you get a minute, can you take a look at the attachment and the email string below and give me a call or stop by when you' re in the area ? You submitted the first item which we did by Resolution ( see attachment 20190274), so I ' d like your feedback on whether this correction should require any memo explaining the information for the Board , or if it is just a Consent addition . Thanks ! Esther E. Gesick Clerk to the Board 1150 O Street / P. O. Box 758 / Greeley, CO 80632 tel: (970) 400-4226 1 3 a , : : t1 Ft !• t It ppK..' -. :, ✓gam`:=.�"" t ;p6 Confidentiality Notice : This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication . Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited . From : Esther Gesick <egesick@weldgov . com > Sent: Wednesday, August 28, 2019 11 : 51 AM To : Toby Taylor <ttaylor@weldgov . com > Cc : Esther Gesick <egesick@weldgov . com >; Cheryl Hoffman < choffman@weldgov . com > Subject : FW : Reclamation Variance : Sam F 11-9 Hi Toby, It looks like this item slipped through the cracks and I ' m trying to pick up the pieces and figure out what to do with it . Would you take a look at the attachment and the email string below and give me a call or stop by when you ' re in the area ? Thanks ! Esther E. Gesick Clerk to the Board 1150 O Street / P. O. Box 758 / Greeley, CO 80632 tel: (970) 400-4226 1 ,fir: F H Sl R Confidentiality Notice : This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure . If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication . Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited . From : Kaiti Hines < khines@srcenergy. com > Sent: Friday, August 23, 2019 9 : 36 AM To : Esther Gesick <egesick@weldgov . com > Cc : Chloe Rempel <crempel@weldgov. com >; Stephanie Frederick <sfrederick@weldgov . com >; Cheryl Hoffman < choffma n @weldgov . com > Subject: RE : Reclamation Variance : Sam F 11-9 Caution: This email originated from outside of Weld County Government. Do not click links or open attachments unless you recognize the sender and know the content is safe. Esther, Here' s the document needing signature . Thanks for the update . Kaiti From : Esther Gesick < egesick@weldgov . com > Sent : Friday, August 23, 2019 9 : 33 AM 2 To : Kaiti Hines < khines@srcener,gy . com > Cc : Chloe Rempel <crempel@weldgov . com >; Stephanie Frederick <sfrederick@weldgov . com >; Cheryl Hoffman < choffma n @weldgov . com > Subject : RE : Reclamation Variance : Sam F 11-9 CAUTION : This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. Hi Kaiti, Unfortunately, I 've been searching our database records and have been unable to locate evidence that it was ever completed as intended . Let me check with some of the other folks in the office to see if they have any record or background on the matter and I ' ll get back to you . The email string you provided is older than what I have access to, so would you also be able to resend the documents that were originally attached ? Thank you, Esther E. Gesick Clerk to the Board 1150 O Street / P. O. Box 7581 Greeley, CO 80632 tel: (970) 400-4226 Confidentiality Notice : This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication . Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited . From : Kaiti Hines < khines@srcenergy . com > Sent : Friday, August 23, 2019 8 : 35 AM To : Esther Gesick <egesick@weldgov . com > Cc : Bethany Ford < bford@weldgov . com >; Chloe Rempel <crempel@weldgov . com >; Stephanie Frederick <sfrederick@weldgov . com > Subject : RE : Reclamation Variance : Sam F 11-9 Importance : High This email originated from outside of Weld County Government. Do not click links or open attachments unless you recognize the sender and know the content is safe. Esther/ Good morning, Was this ever signed ? Thanks, Kaiti From : Esther Gesick <egesick a weldgov . com > Sent: Thursday, April 18, 2019 8 : 26 AM To : Kaiti Hines < khines@srcenergy. com > Cc : Bethany Ford < bford@weldgov . com >; Chloe Rempel < crempel@weldgov . com >; Stephanie Frederick 3 < sfrederick@weldgov . com > Subject : RE : Reclamation Variance : Sam F 11-9 CAUTION : This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. Thank you, Kaiti . We will get this processed on the upcoming Agenda for Monday, April 22nd and then return the finalized documents to you . Regards, Esther Ea Gesick Clerk to the Board 1150 O Street / P. O. Box 7581 Greeley, CO 80632 tel: (970) 400-4226 gp,ry��,yC t n. p �i 1 1r 11M42 . 1 A ta Confidentiality Notice : This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication . Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited . From : Kaiti Hines < khines@srcenergy . com > Sent : Thursday, April 18, 2019 7 :48 AM To : Esther Gesick <egesick@weldgov . com > Cc : Bethany Ford < bford@weldgov . com >; Chloe Rempel <crempel@weldgov . com > Subject : RE : Reclamation Variance : Sam F 11-9 Importance : High Caution : This email originated from outside of Weld County Government. Do not click links or open attachments unless you recognize the sender and know the content is safe. Good morning, The first email with the Reclamation Variance from March 7th had some incorrect data on one of the Exhibits . An email was sent from the landman, Matt Jones, regarding that mistake . The second email of the Reclamation Variance from April 10th is the final one that should be signed . The only parts of that Reclamation Variance (April 10th email attachment) that Barbara needs to sign is the Exhibit A letter (the Executed Final Reclamation Agreement) and initial the front cover of the Exhibits . We need a copy of that sent back to us so we can file send the entire packet to the COGCC requesting a variance approval . You all may keep the signed originals in your file as you see fit . Thanks, Kaiti Hines From : Esther Gesick <egesick@weldgov . com > Sent: Wednesday, April 17, 2019 11 :45 AM To : Kaiti Hines < khines@srcenergy . com > Cc : Bethany Ford < bford@weldgov . com >; Chloe Rempel <crempel@weldgov . com >; Esther Gesick 4 <egesick@weldgov. com > Subject : FW : Reclamation Variance : Sam F 11-9 Importance : High CAUTION : This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. Hello Kaiti, I just left you a voice message concerning this email string and a request for some additional clarification . I ' ll await your reply . Thank you , Esther E Gesick Clerk to the Board 1150 O Street/ P. O. Box 758 / Greeley, CO 80632 tel: (970) 400-4226 . C :4‘,, ,- - i i 'w t j r i r 1 t„.. . - 4 Confidentiality Notice : This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e- mail and destroy the communication . Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited . From : Esther Gesick Sent : Thursday, April 11, 2019 1 : 11 PM To : Cheryl Hoffman <choffman@weldgov . com >; CTB <CTB@cooweld . co . us> Cc : Toby Taylor <ttaylor@weldgov . com >; Sterling Geesaman <sgeesaman@ weldgov . com > Subject: FW : Reclamation Variance : Sam F 11-9 importance : High Cheryl - I think the existing application should remain as a stand -alone document in Tyler and this should be listed under Communications with a See Also to #2019-0274 to supplement the public record . The same would go for any Final Waiver documentation . Toby - Thoughts ? Esther E. Gesick Clerk to the Board 1150 O Street ' P. O. Box 7581 Greeley, CO 80632 tel: (970) 400-4226 u fi r yy� Confidentiality Notice : This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication . Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited . Frtm : Cheryl Hoffman Sent Wednesday, April 10, 2019 8 : 13 AM 5 To : CTB <CTB@co . weld . co . us> Subject : FW : Reclamation Variance : Sam F 11-9 Importance : High Esther, this was on the agenda January 14, 2019 . I' m not sure if this needs to just be scanned in to add to the 2019-0274 file, or if this is a communications item too since there is a lot more to the file ? In Tyler there is only the resolution, memo and final reclamation consultation form signed by BK . Cheryl Hoffman Deputy Clerk to the Board Weld County Clerk to the Board Office 1150 O Street Greeley, CO 80631 970.400. 4227 t R Confidentiality Notice : This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged , confidential or otherwise protected from disclosure . If you have received this communication in error, please immediately notify sender by return e- mail and destroy the communication . Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited . From : Kaiti Hines < khines@srcenergy. com > Sent : Wednesday, April 10, 2019 7 : 52 AM To : Toby Taylor <ttaylor@weldgov . com >; Sterling Geesaman < eesaman@weldgov . com >; Cheryl Hoffman <choffma n @weldgov . com > Cc : Matt Jones < m 'ones@srcenergy . com > Subject : RE : Reclamation Variance : Sam F 11-9 Importance : High This email originated from outside of Weld County Government. Do not click links or open attachments unless you recognize the sender and know the content is safe. Good morning, Our sincere apologies for the delay on getting the revised Reclamation Variance for the Sam F 11-9 well over to you . Please see the attached for approval signature, date, and initials . Please keep a copy for yourself and return a copy back to me and CC m 'ones@srcenergy . com . Thank you, Kaiti Hines From : Kaiti Hines Sent: Thursday, March 7, 2019 12 :48 PM To : 'ttaylor@weldgov . com ' <ttaylor@weldgov . com >; ' sgeesaman@weldgov . com ' < sgeesaman@weldgov . com >; ' choffman@weldgov . com ' <choffman@weldgov . com > 6 Cc : Matt Jones < mjones@srce rgy . com > Subject: Reclamation Variance : Sam F 11-9 Good afternoon, Please see the attached Reclamation Variance for the Sam F 11-9 well that was plugged and reclaimed in September 2018 . If the terms and conditions of the Final Reclamation Agreement are satisfactory, please sign and date that agreement, and initial the first page of the Exhibits . Please return a fully executed copy back to me and CC mtonessrcenergy . com Please let me know if you have any questions or concerns . Thanks, Kaiti Hines Land Technician 5400 W . 11th St ., Suite C, Greeley, CO 80634 Office : 970-475-5220 I Direct : 970 .475 . 5240 I khines@srcenergy .com set\ - Y yy y SRC, ENERGY kialt This message, including any attachments, is intended only for the use of the individual ( s ) to which it is addressed and may contain information that may be privileged/confidential and protected from disclosure . Any other distribution, copying or disclosure is strictly prohibited . If you are not the intended recipient or have received this message in error, please notify us immediately by reply e- mail and permanently delete this message including any attachments, without reading it or making a copy . Thank you . 7 Hello