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loan Apprmra. OME No. 7000-00/7. Approref efpnes 530-~' <br /> UNITED siP1EE ENVIFONMEMAI PROTECTION PGF NCY <br /> WASHINGTON. DC IOftA <br />~- E PA APPLICATION TO TRANSFER PERMIT <br /> <br /> NFME AND ADDRESS OF EXISTING PERMFTTEE NFME PND PDDRE55 OF SURFPCE OWNER <br /> STATE COUNTY - PERMIT NUMBER <br /> LOCATE WELL PND OUTLINE UNn ON <br /> SECTION PUT -640 ACRES <br /> ' SURFPCE LO CATION bESCRIPT10N <br />N `A OF ~6 OF ,ti SF C710N TOWNSHIP RPNGE <br />~~~ ~~~ LOOPTE WELL IN TWO DIRE CIIONS FROM NE?RE:I UNES OF OUPFTER SE CTION PND DRILLING UNn <br />I I I I ' I surface <br />TT'T TTT Loutwn _ h, from IN/S) _ Lina d oeener aeciion <br />I 1 enE _ fi. hom [ Line pf Darter arCTiOn <br />I I I I I WELL AL7IVITY WELT S7A7U5 , TYPE OF PERMIT <br />E D Clsas I D Operrtinp ^ Intlivitluel <br />W <br />^ Class II ^ Mooification/Conversion O Area <br />I I <br />L1 1_11 OBrine Disposal D Prol>obed Number o1 Walla ~_ <br />1 <br />_ <br />~ <br />D Enhancetl Recovery <br />I I ( <br />I <br />D Nytlrocartwre 5torepe <br />-.-.-~----t-- -t--{--}- ^ Class III <br />1 I 1 ~~~ D OTher <br />i I I i ~ I lease Name Well Number <br />B <br />NPMEIS) AND PDDRESSlE51 Of NFW OWNF 8151 NAME PND ADDRESS OF NFW OPERATOR <br />Anach io this application a written agreement between The existing and new permittee containing a <br />specific date for transfer of permit responsibility, coverage, and liability between them. <br />The new perminee must show evidence of financial responsibility by the submission of surety bond, or <br />other adequate assurance, such as financial statements or other materials acceptable to the director. <br />CERTIFICATION <br />I cenify under the penalty ollaw that /have personally examined and am familiar with the in/ormation <br />submined in this document and a// anachments and that, based on my inquiry of those individuals <br />immediately responsible for obrsining the inlormation, l believe that the inlormation is true, accurate, <br />sndcomplete. lsm aware that there are signi/icant penahies /or submining la/se in/ormation, including <br />the possibility olline and imprisonment. /Rel. 40 CfR 144.32) <br />NFME PND OFFICWI TRLE /Pbefe type a print/ SIGNATURE DPTE SIGNED <br />EPA Form7bY0-7IZ-64) <br />