Laserfiche WebLink
Fam3160 -3 <br />(August 2007) <br />UNITED STATES <br />DEPARTMENT OF THE INTERIOR <br />BUREAU OF LAND MANAGEMENT <br />FORM APPROVED <br />OMB No. 100"137 <br />Expires July 31, 2010 <br />5. Lease Serial Na <br />C-0118327 <br />APPLICATION FOR PERMIT TO DRILL OR REENTER I ftIndian Allotee or Tribe Name <br />na <br />Ia. Type of work: QDRILL O REENTER <br />7 If Unit or CA Agreement, Nam and No. <br />Natural Soda, Inc. <br />lb, Type of Well: [306 wen t ras Well QOtha Single Zone C] Multiple Zone <br />$. Lease Nance and Well No. <br />1611-1 <br />2 Name of Operator Natural Soda, Inc. <br />9, API Well Na <br />na <br />31. Address 3200 Rio Blanco County Road 31 <br />3b. Phone Na (rwh& wra ca*) <br />10_ Field and Pool, or Exploratory <br />Rifle. CO 81650 <br />(970) 878 -3674 <br />Boies Bed, Nahcolite <br />4. Location of Well (Report legion clearly avid in uccmbu with any &w +ex2rer+a m *) <br />11. Sec., T. R. M. or Blk. and Survey or Area <br />At surface Latibude 39.926716523 N Longitude 108.371248552 W, NAD83 <br />SHL: Sec 34, T1S, R98W, 6th P.M. <br />At proposed prod. zone <br />14. Distance in miles and direction from nearest town or past oft& <br />12. County or Parish <br />13. State <br />45 miles soudiumat of Meeker Colorado <br />Rio Blanco <br />CO <br />15. Distance from pmposed' 194 ft. <br />location m <br />1 No. of acres in lease <br />17, Spacing Unit dedicated io this well <br />nearest <br />Property or lease line, ft. <br />8 2.6 <br />Also to nearest drig. unit line, if any) <br />18 Distance from location• 69 ft. <br />� <br />19. Proposed Depth <br />20. BL 4MU Bond Na on file <br />to nearest well completed, <br />applies for, on this lease ft <br />–4675 ft MD <br />–1827 ft.TVD <br />21. Elevations (Show wbetherDF, KDB, RT, GL, etc.) <br />22 Approximate date work will start' <br />23. Estimated duration <br />GL <br />0810312015 <br />35 days <br />24. Attachments <br />The following, completed in accordance with the requirements of Onshore Oil and Gas Order No. 1, must be attached to finis farm: <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 />hem 20 above). <br />5. Operator certification <br />6. Such other site specific information and/or plans as may be required by the <br />BLM. <br />25. Signal» re Name (Printetb7*d) Date <br />Xa I Gerald Daub f .� <br />Title <br />Preeklent, Daub & Associates, Inc. <br />Approved by Ogw —) Name (ftVe- &TMwd) Date <br />Tide I Office <br />Application approval does not warrant or certify that the applicant holds legal or equitable tide w draee rights in the subjectleasewhich world endue the applicantto <br />conduct operations thereon. <br />Conditions of approval, if any, are attached. <br />Tide I U.S.C. Section 1001 ardTitle 43 U.S.C. Section 1212, make its crime forany person kmwimJy and willfully to make to any department or agency ofthe United <br />States any false, fictitious or fraudulent statements or representations as nt any matter within its juri rchom <br />(Continued on page 2) *(Instructions on page 2) <br />