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lUL-30-97 WED 10:49 nM <br /> <br />aw Colorado ReesivBd <br />1U DJq.1el~_ State of Colorado f Roo ~ NAY <br />OII and Gas Conservation Comrl#ogH997 QA1D <br />DEPARTMENT OF NATURAL RES°UAGES p''NO' <br />CERTIFICATION OF CLEARANCE ANO/OR CHANGE OF OPERATOR SEC 9C L4`!g <br />quhmlt mlgfml albs e• mmy cop4H a ihs number of Welb plus en t6) addl0on+1 oopb•. Ua• 1r <br />Pepe S oI Porm 10 far mulDpl• vnlle ehenglnq from the tome aDerptpr to Iha new optrelpr or CppC~' <br />when Ue'Chanpe of Tran<portsr/GaNwer' on mulUpla ..all, pre the •pm•. 7hl• lorm le nel le be <br />utab for Wall Nem• ehangaa or 81+tua ehangea. A sapar•t• PORM 10 mutt bt tubMaad (er r< oe .• <br />each nplu eompletlon end a FORM 70 for etU produelnp lermttlen of ^ Mulllpl• Cempl•8on. It It <br />the ODaratafa reapontibiliry to mail approved caDleL to Ina new Traneponer enNor OeUerw (or <br />eacn wall Ilatad. <br />Operator Bond 8tal <br />OGCC Op•r•eor NUmb•r: 83530 Conber NSm•e Phony © Bl+nkel <br />Nvne ol0 lor. $CTOUd O1I pro +TLia6. RC. Lta <br />• <br />wcere•s~ p e OltiLa Bo% 9 No: <br />- ^ Indlvldu+l <br /> <br />® Change of Operator Q Change o(Trnn~porter or Gatherer <br />Ena<tive Oata: Eflactlva D+ta: <br />Complptp Tnls 5•cLOn For a Now orlndlvldua! Wall. <br />OCCC YY No; P NumOeC <br />D.S- <br />1Vee Name Ntl NumYr. eb Neme en Numtac <br />Lm•Bon lOwo, Bee, Twp, Rnp, Meddlen): ~ Awn n LYn: <br />Mlrl A6Y0'Iepb WeO 9Weup <br />L.ytlwm RvyHIY ~Nror: FY <br />FWmI aY{• <br />Indlen el.(p. P•eMI0r 41wN <br />Ls••e Na <br />WB~eI Wler DlspoW <br />F.Wry vwa Pe Numbr. ^ C.nuw Pe <br />On.eb PB CmnrroW Pp <br />Ir~edbn WY NA <br />prptlmnp FermsCen(s): Re[dnd•eoni <br />Cwanl WY Shlu•: Dab $nN In a ProdlY:ton RYUm•e: <br />LLA Dm w.u LYYi <br />N Y II yee. Innresn mvw b woman. <br />If •awuq GGCC Wu, leau ne: <br />L <br />OIL TRANBPORTER OA6 GATHERER <br />Hams e(W iransportn OGCC OpePlpr He. Hem• M Gas GetNro OGCC Opnta Ho. <br />bdYa LJLesa <br />Ger +rwe rlp CBr ebb : 21p <br />be • • um r <br />( 1 we r n NY a• • r e • e Ws TNS rormaYVn <br />I ) <br />11 Multlpl+Tnn+porfar or O+thenr, Compl+t+W+F6llowlny: <br />OIL TRANf PORTCA W1E OATHCRGR <br />uem. el OY [nropenr OOCC OpwLLer o. NwM w OY OaUww 00 O W Nee Ne. <br />Add,.Y Aeenu <br />cry 9bre p <br />N.. em. rmn. enrroer vue d raw rivmrtwn TNL ronrWlon <br />1 7 Cei SW p <br />NY ece• rnarr NUnp•r Om a ruw e•r• TNa romueen <br />( ) <br /> <br /> <br /> <br /> <br />rha W rsien.e eanRb Ptl N. No ...a nev411one ai rha 01 an• Oa r--wnlan xomN..Yr, H'M boa M 4mN luv 1.Y as,yuat .pa. saun ss <br />.w,.d ,bo...N N.r N. 4.a.MMJ b IrJ .u~M1Slad u,ranaa J,. M enYly pu rWUwI IT pu eYa.. •..0.J wp.N Baal rFb rvN/Y.rW rYl b <br />.alb uma ~uur nseW a me veeeae+r nunY arch er uma .,_ -.~Y •. W mveae 01 W eee Gene dae mm,YeYw. <br />Baler or CUnmtOan LO wr• <br />H•me of Canby a Pre <br />$ roud 011 Pro [ias, Inc. 8aein Rac ices. Int. <br />TNa owe Twa Dab <br />?resident / 12/1y6/~96 property tf+nager <br />~y . J . ~Lw.c-yc.+_ry <br />GCC AD-rwed' ./~ Ta•' B1Rt:e~en °a1e'~=-~: i99f~- <br />oacCowrnn <br />_ _ ~. <br />P. 4 <br />ffiIBIT 31-73 <br />