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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 APPROVM <br />M% JW"137 <br />Expires July 31, 2010 <br />5. Lease Serial No, <br />C- 0118327 <br />6. If Indian, Allotee or Tribe Name <br />na <br />Ia. Type of work: QDRiLL REENTER <br />7 K Unit or CA Agreement, Name and No. <br />Natural Soda, Inc. <br />lb. Type of Well: 11 oil well 0 Gas well [Z] Other Single Zone [:] Multiple Zone <br />8. Lease Name and Well No. <br />16H-R <br />2 Name of Operator Natural Soda, Inc. <br />9, API Well Na <br />na <br />3a Address 3200 Rio Blanca County Road 31 <br />1 <br />3b Phone area co* <br />10. Field and Pool, or Exploratory <br />Rifle, CO 81650 <br />(970) 87 &3874 <br />Baas Bed, elite <br />4. Location of Well (Report taaa m awry and w xcwAxu with *V SA* imam. *) <br />11. Sec., T. R M. or Bik. and Survey or Area <br />At surface Latitiude 39.926378924 N Longitude 108.3710987 W, NAD83 <br />SHL: Sec 34, T1 S, R98W, 6th P.M. <br />At proposed prod. zone <br />14. Distance in miles and direction from nearest town or post aQix* <br />12. County or Parish <br />13. State <br />— 45 miles souffwmd of Meeker Colorado <br />Rio Blanco <br />CO <br />15. Di5 = from Wop0sW* 317 fL <br />l No. of in lease <br />17. Spacing Unit dedicated to this well <br />location to nearest <br />penny or lease line, ft. <br />Also to nearest drig. unit fine, if any) <br />86 <br />18. Distance from proposed location* 77 ft. <br />19. Proposed Depth <br />20. BLM81A B Na on file <br />aas <br />to nearest well, drillrrrg, completed, <br />applied for, an this lease, ft. <br />—2418 ft MD <br />—1845 RTVD <br />21 Elevations (Show whether DF, KDB, RT, GL, etc.) <br />22- Approximate date work will start* <br />23 Eatimated duration <br />GL <br />09/0712015 <br />128 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 this Exam: <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 fled 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 and/or plans as maybe required by the <br />Application approval does not warrant or certify that the applicant holds legal orequitable title to those rights in the subjex tleasewhich would entitle the applicantto <br />conduct operations thereon. <br />Conditions of approval, if any, are attached. <br />Title 18 U.S.C. Section 1001 a dTttle 43 U.S.C. Section 1212, make it a form persar kraw ly and wihfully to make to any department or agency of the United <br />States any false, fictitious or fraudulent statements or representations as to any matter within its j coon. <br />(Continued on page 2) *(Instructions on page 2) <br />