2015-08-18_HYDROLOGY - P2014014

• Permit No: P2014014
• IBM Index Class Name: HYDROLOGY
• Doc Date: 8/18/2015
• Doc Name: Re: Simple Oil LLC Lease
• From: Daub & Associates
• To: DRMS
• Email Name: THM
• Media Type: D
• Archive: No

Form 3160-3
(August 2007)
UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
APPLICATION FOR PERMIT TO DRILL OR REENTER
FORM APPROVED
OMB No. 1004-0137
Expires July 31, 2010
5. Lease Serial No.
COC74299
6. If Indian, Allotee or Tribe Name
N/A
Ia. Type of work: Q✓ DRILL ❑ REENTER
7 If Unit or CA Agreement, Name and No.
Simple Oil LLC
Ib. Type of Well: � Oil Well ❑ Gas Well Z✓ Other � Single Zone Multiple Zone
8. Lease Name and Well No.
OSR-1
2 Name of Operator Simple Oil LLC
9. API Well No.
3a. Address 3200 Rio Blanco County Road 31
3b. Phone No. (include area code)
10. Field and Pool, or Exploratory
Rifle, CO 81650 1
[phone]
Oil Shale RD&D Well
4. Location of Well (Report location clearly and in accordance with wiy State requirements. *)
11. Sec., T. R. M. or Blk. and Survey or Area
At surface Latitude 39.925876403'N, Longitude 108.364571952'W (NAD 83)
Section 35, T1S, R98W, 6th P.M.
At proposed prod. zone Same
14. Distance in miles and direction from nearest town or post office*
12. County or Parish
13. State
—40 miles southwest of Meeker, Colorado
Rio Blanco
CO
15. Distance from proposed*
location to nearest
16. No. of acres in lease
17. Spacing Unit dedicated to this well
property or lease line, ft.
(Also to nearest drig. unit line, if any)
160
18. Distance from proposed location*
to nearest well, drilling, completed,
applied for, on this lease, ft.
19. Proposed Depth
—2900' MD &TVD
20, BLMBIA Bond No. on file
21. Elevations (Show whether DF, IDB, RT, GL, etc.)
22 Approximate date work will start*
23. Estimated duration
6705 GL
24. Attachments
The following, completed in accordance with the requirements of Onshore Oil and Gas Order No.], must be attached to this form:
1. Well plat certified by a registered surveyor.
2. A Drilling Plan.
3. A Surface Use Plan (if the location is on National Forest System Lands, the
SUPO must be filed with the appropriate Forest Service Office).
4. Bond to cover the operations unless covered by an existing bond on file (see
Item 20 above).
5. Operator certification
6. Such other site specific information and/or plans as may be required by the
BLM.
25. Signature
Name (Printed/Typed)
Date
Title , n
Approved by (Signature)
Name (Printed/Typed)
Date
Title
Office
Application approval does not warrant or certify that the applicant holds legal or equitable title to those rights in the subjectlease which would entitle the applicantto
conduct operations thereon.
Conditions of approval, if any, are attached.
Title 18 U.S.C. Section 1001 and Tide 43 U.S.C. Section 1212, make it a crime for any person knowingly and willfully to make to any department or agency of the United
States any false, fictitious or fraudulent statements or representations as to any matter within its jurisdiction.
(Continued on page 2) *(Instructions on page 2)