Laserfiche WebLink
Fan 3160 -3 <br />(August 2007) <br />UNITED STATES <br />DEPARTMENT OF THE INTERIOR <br />BUREAU OF LAND MANAGEMENT <br />FORM APPROVED <br />OMB No. 1004 -0137 <br />Expires July 31, 2010 <br />i. Lease Serial Nor <br />C-0118327 <br />APPLICATION FOR PERMIT TO DRILL OR REENTER I & ifItxfran,Allaee �TrifreName <br />nor <br />Ia. Type of work: Q✓ DRILL ❑ REENTER <br />7 If Unit or CA Agreement, Name and No. <br />Natural Soda, Inc. <br />lb. Type of Well: Oil Well Gas Well �Olher Single Zone E] Multiple Zone <br />8. Lease Name and Well No. <br />17H-R <br />2 Nance of Operator Natural Sofa, Inc. <br />9. API Well Na <br />na <br />3a. Address 3200 Rio Blanco County Road 31 <br />3b. Phone Nm ("ali,* �Q ) <br />10. Field and Pool, or Exploratory <br />Riffs, CO 81650 <br />(970) 878.3674 <br />Bolas Bed, Nahcoke <br />4. location of Well (Report kaawn cka* aW m,oarmtm wIlk m9' &W rrgrd ww& s) <br />11. See., T. R. M. or BIL and Survey or Area <br />At surface Latitiude 39.925849781 N Longitude 108.370869811 W, NAM <br />SHL: Sec 34, T1S, R98W, M P.M. <br />At proposed prod. zone <br />14. Distance in miles and direction from nearest town or post ot5ce' <br />12. County or Parish <br />13. State <br />— 45 miles southwest of Meeker Colorado <br />Rio Blanco <br />CO <br />15. Distance fio a poposed* 509 ft. <br />location to nearest <br />16. No� f main lease <br />8382 <br />17. Spacing Unit "CAW to this well <br />or lease line, li <br />Also to neared drig. unit lice, if any) <br />I& Distance from proposed location" 115 ft. <br />19. Proposed Depth <br />20. BLMA31A Bout Na on file <br />to nearest well, drilling, completed, <br />applied for, on this lease, k <br />—2418 ft. MD <br />—1843 ftTVD <br />21. Elevations (Show whetherDF, KDR RT, GL, etc.) <br />22 Approximate date work will start• <br />23. Estimated duration <br />GL <br />11/09/2015 <br />28 days <br />24. Attachments <br />TIM following, completed in accordance with the requirements of Onshore 09 and Gas Order No. 1, rtntst be attached io this form: <br />I. 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 />25. Signature <br />Title <br />President, Daub & Associates, Inc. <br />Approved by ft-a-) <br />Title <br />4. Bond to cover the operations unless covered by an existing band on file (see <br />Item 20 above). <br />5. Operator certification <br />6. Such other site specific information and/or plants as may be required by the <br />BILK <br />Name Mdnwd1TTMmd) <br />Gerald Daub <br />Name (Priii MIType0 <br />K5 <br />Date <br />Date <br />Application approval does not warrant or certify that the applicant holds legal or equitable title to those rights in the subject leasewhich would entitle the applicant to <br />conduct operations thereon. <br />Conditions of approval, if any, are attached. <br />Title 18 U.S.C. Section 1001 and Tide 43 U.S.C. Section 1212, mate it a crime for any person kn;L'n y and willfidly 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 ' oa <br />(Continued on page 2) *(Instructions on page 2) <br />