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Form3160 -3 <br />(August 2007) <br />UNITED STATES <br />DEPARTMENT OF THE INTERIOR <br />BUREAU OF LAND MANAGEMENT <br />APPLICATION FOR PERMIT TO DRILL OR REENTER <br />FORM APPROVED <br />ONS No. 1004-0137 <br />Expires July 31, 2010 <br />5. Lease Serial Na <br />C- 0118327 <br />6. If Indian, Allotee or Tribe Name <br />na <br />Ia. Type of work: [Z]DRILL F1 RIDITF,R <br />7 If Unit or CA Agreement, Name and No. <br />Natural Soda, Inc. <br />lb. Type of Wdl: 13 Oil Well ❑ Gas Weil aOdrer Single Zone [] Multiple Zone <br />a. Lease Name and Well No <br />15H4 <br />Z Name of Operator Natural soda, Ina <br />9. API Well No. <br />na <br />3a. Address 3200 Rio Blanco County Road 31 <br />1 <br />3b. Phone ND. (mdurk area mk <br />10. Field and Pool, orExplomtory <br />Rifle, CO 81650 <br />(970) 878 -3674 <br />Boies Bed Nahcol to <br />4. Location of Well (Rrpon k osam ckm'fy and in aewdmrce widr any A* regwamm#) <br />11. Sac., T. R M. or Bik.and Survey or Area <br />At surface LaNude 39.927254552 N Longitude 108.371481672 W, NAD83 <br />SHL: Sec 27, T1S,Ft98W, 6th P.M. <br />At proposed prod. zone <br />14. Distance in miles and direction from nearest town or post oSne* <br />12. County or Parish <br />13. State <br />– 45 miles southwest of Meeker Colorado <br />Rio Blanco <br />CO <br />15. Dime from inoPosed* 3 fL <br />I6. No. of aces in lease <br />17. Spacing Unit dedicated to this well <br />location to ocar� <br />8382 <br />or lease line, I <br />Also to nearest drig. unit line, if any) <br />I& Distance from pvposed location* 128 ft. <br />9. Proposed Depth <br />20. BLMBIA Bond Na on file <br />to nearest well, completed, <br />applied for, on this lean, ft. <br />–4675 ft. MD <br />–1829 fLTVD <br />21. Elevations (Show wbetherDF, KDB, RT, GL, etc.) <br />22. Approximate date work will stall <br />23. Estimated duration <br />GL <br />06101/2015 <br />1 35 days <br />24. Attachments <br />Tice following, completed in accordance with the requiremmts of Onshore Oil and Gas Order No.), must be attached b this form: <br />1. Well plat certified by a registered surveyor. <br />2 A Drilling Plan. <br />3. A Surface Use Plan (if the location is on National Forest System Lands, the <br />SUPO must be filed with the appropriate Forest Service Office), <br />4 Bond to cover the operations unless covered by an existing bond on file (see <br />Item 20 above). <br />5. Operator certification <br />6. Such other site specific information andtor plans as maybe required by the <br />BLM. <br />25. Signature Name Daub <br />(a rJ�ped} <br />Gerald D Daub ! <br />Title <br />President, Daub & Associates, Inc. <br />Approved by M5-not) Name (PKn1edf7)ped9 Date <br />Title I Office <br />Application approval does not warrant or certify that the applicant holds legal orequitable tide w those rights in the subiectlease which would entifle the applitantto <br />conduct operations tam. <br />Conditions of approval, if arty, are attached. <br />Tide I US.C. Section 1001 and Tide 43 U.S.C. Section 1212, make it a crime for any person 'y and willfully to make to any department or agency of the United <br />States any false, fictitious or fraudulent statements or represanations as to any matter within its Jun xenon. <br />(Continued on page 2) *(Instructions on page 2) <br />