Spreadsheet: 10dc77c7-5f5e-4e2b-a30b-128ac5386aeb
Sheet: Sheet1

Unnamed: 0 | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | Unnamed: 14 | Unnamed: 15 | Unnamed: 16 | Unnamed: 17 | Unnamed: 18 | Unnamed: 19 | Unnamed: 20 | Unnamed: 21
 |  | WELL PLUGGING PLAN |  |  |  |  |  |  | FOR STATE USE ONLY
 |  | State Form 54872 ( R / 2-14) / Form No. P2 |  |  |  |  |  |  | Date received (month, day, year) |  |  |  |  | Initials
 |  | INDIANA DEPARTMENT OF NATURAL RESOURCES |  |  |  |  |  |  | Date approved (month, day, year) |  |  |  |  | Initials
 |  | Division of Oil and Gas
 |  | 402 W. Washington St., Rm. 293 |  |  |  |  |  |  | Date denied (month, day, year) |  |  |  |  | Initials
 |  | Indianapolis, IN  46204
 |  | Telephone number: (317) 232-4055 |  |  |  |  |  |  | Date modified (month, day, year) |  |  |  |  | Initials
 |  | FAX  number: (317) 232-1550
 |  | Internet: http://www.in.gov/dnr/dnroil
 |  |  |  |  |  | WELL PLUGGING PLAN
Name of operator |  |  |  |  |  | Telephone number |  |  |  | Fax number |  | E-mail address
Lease-Well number |  |  |  |  | Type of Well |  |  | Permit number |  |  |  | Date (month, day, year)
County |  |  |  | Scheduled plugging date (month, day, year) |  |  |  |  |  | Section |  | Township |  | Range
 |  |  |  |  | Ground  Level |  |  |  | [NAME] |  |  | Underground Source of Drinking Water
SURFACE
Size | Length | Hole |  | Cement |  |  |  |  |  |  |  | Coals to protect
LONG STRING |  |  |  |  |  |  |  |  |  |  |  | Well flowing?
Size | Length | Hole |  | Cement
LINER / INTERMEDIATE CASING |  |  |  |  |  |  |  |  |  |  |  | Is well located in a commercially minable coal resource area?
Size | Length | Hole |  | Cement
 |  |  |  |  |  |  |  |  |  |  |  | If so, was the entity with rights to the coal notified?
Estimate top of cement |  |  |  |  |  |  |  |  |  |  |  | If yes, what date notified (month, day, year):
WELL [NAME] |  |  |  |  |  |  |  |  |  |  |  | Who was notified?
 |  |  |  |  |  |  |  |  |  |  |  | Contact number:
EXISTING PERFORATIONS
From |  | To |  |  |  |  |  |  |  |  |  | Comments:
From |  | To
From |  | To
PROPOSED PERFORATIONS
From |  | To
From |  | To
From |  | To
Amount of proposed casing to pull
PROPOSED [NAME] AND [NAME]
Plug number |  | Type |  | Volume
Plug  1
Plug  2
Plug  3
Plug  4
 |  |  |  |  |  |  |  | Open               hole
 |  |  |  |  | Total depth |  |  | Plugged back total depth
AFFIRMATION
I affirm under penalty of perjury that the information provided in this plan is true and correct to the best of my knowledge and belief.  Furthermore, I understand that this plan will not be valid until approved by the Division of Oil and Gas and that upon said approval, it will remain valid for a period of not more than 180 days thereafter, unless the construction of the well has changed which also voids the plan.
Signature of operator or authorized agency |  |  |  |  |  |  |  |  |  |  |  |  | Date signed (month, day, year)
 | Cement |  |  | CIBP |  |  |  | Packer |  |  | Spacer
SPECIAL INFORMATION
1 | For dry holes, the owner or operator is required to give verbal or written notice of intent to plug a well to the oil and gas inspector at least twelve (12) hours before beginning the plugging of the well.
2 | For all existing wells, the owner or operator must give written notice of intent to plug by submitting this completed form at least ten (10) days before beginning the plugging of the well.  All plugging plans should be  sent directly to the Evansville field office via fax at [PHONE], or by email to [EMAIL] .
3 | If a well is located within an area of a commercially minable coal resource, the coal owner must be given at least fifteen (15) days to review the plan.
4 | The owner or operator may not begin the plugging of any existing well until after receipt of written approval from the Department of the plan.
5 | The owner or operator shall give an oil and gas inspector verbal or written notice at least forty-eight (48) hours before the scheduled time to begin plugging operations of an existing well.
6 | If an emergency or urgent condition exists with a well and delay in plugging could cause harm to the environment or threaten public health and safety, an owner or operator may begin plugging a well upon verbal approval from the division director or a designated representative of the division director.
7 | An owner or operator must submit a completed Well Plugging Report within thirty (30) days upon completion of the plugging operations.
8 | Should an owner or operator be unable to complete the plugging of a well according to this plan due to unforeseen problems, you must receive written or verbal authorization to continue plugging operations from  the Director or Field Supervisor.
9 | The approval of this plan, or changes to this plan during actual plugging, does not relieve the applicant from responsibility for future remedial actions on this well as needed to prevent contamination in accordance with  IC 14-37.
10 | All top plugs must be circulated to the surface regardless of the proposed amount of cement to be used as shown in this plan.
11 | You must contact the field inspector within seventy-two (72) hours after the well is plugged, to top off the well, if necessary.
12 | Include with this plan a copy of the most recent completion report for this well.
13 | Keep a copy of your submitted plan for your records.