2021-04-20_REVISION - M1983194 (3)

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Form 3160-3 FORM APPROVED (June 2019) OMB No. 1004-0137 UNITED STATES Expires:October 31,2021 DEPARTMENT OF THE INTERIOR 5.Lease Serial No BUREAU OF LAND MANAGEMENT COC-0119986 APPLICATION FOR PERMIT TO DRILL OR REENTER 6 If Indian,Allotee or Tribe Name la Type of work: F✓ DRILL ❑REENTER 7.If Unit or CA Agreement,Name and No. lb. Type of Well: r I Oil Well F1 Gas Well a Other 8.Lease Name and Well No. Ic. Type of Completion: El Hydraulic Fracturing Single Zone ❑Multiple Zone PA-1 2. Name of Operator 9.API Well No. Natural Soda LLC 3a Address 3b. Phone No (include area code) 10 Field and Pool,or Exploratory 3200 Rio Blanco Cty Rd 31,Rifle CO,81650 4. Location of Well(Report location clearly and in accordance with any State requirements.') 11.Sec.,T.W M.or Blk and Survey or Area At surface LAt 39.927757 Long-108.375421 NAD 83 27,T1S,R98W,6th PM At proposed prod.zone 14.Distance in miles and direction from nearest town or post office* 12.County or Parish 13.State —25 miles east-south east of Rangley,CO Rio Blanco CO 15.Distance from proposed' 187 16.No of acres in lease 17.Spacing Unit dedicated to this well location to nearest 2535.9 property or lease line,ft. (Also to nearest drig.unit line,if any) 18 Distance from proposed location* 19.Proposed Depth 20.BLMBIA Bond No,in file to nearest well,drilling,completed,80 520 applied for,on this lease,ft. 21.Elevations(Show whether DF,KDB,RT,GL,etc.) 22.Approximate date work wi11 start- 23.Estimated duration 6617.7 GL July 15,2021 10 days 24. Attachments The following,completed in accordance with the requirements of Onshore Oil and Gas Urdu No.1,and the Hydraulic Fracturing rule per 43 CFR 31623-3 (as applicable) 1 Well plat certified by a registered surveyor 4 Bond to cover the operations unless covered by an existing bond on file(see 2.A Drilling Plan Item 20 above). 3.A Surface Use Plan(if the location is on National Forest System Lands,the 5.Operator certification. SUPO must be filed with the appropriate Forest Service Office) 6 Such other site specific information and/or plans as may be requested by the BLM. 25.Signature Name(Printed/Typed) Date Gerald J Daub Title President Approved by(Signature) Name(Printed,'TJ ped) Date Title Office Application approval does not warrant or certify that the applicant holds legal or equitable title to those rights in the subject lease which would entitle the applicant to conduct operations thereon. Conditions of approval,if any,are attached. Title 18 U.S.C.Section 1001 and Title 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)