| Engineer | Form: (04)
401325103
06/29/2017 | 1) Well has demonstrated lack of mechanical integrity and must be repaired or plugged and abandoned within six months.
2) The additional cement referenced shall be placed as indicated. The placed cement shall be verified with a CBL and documented with a Form 5. No CBL on file with COGCC- verify TOC with CBL and submit.
3) After repair conduct a Mechanical Integrity Test and submit results to COGCC on a Form 21.
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