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lUL-30-97 WED 10;49 nM <br />saw Colorado ReesivBd <br />1U pJq.1el~_ State of Colorado <br />OII and Gas Conservation Comrl#ogH997 <br />~ DEPARTMENT OF NATURAL RFSOUACES <br />•quhmlt mlgfml pIb• as mmy cop4H a ihs number oI We1L Dlu• Ilv t6) •ddlgonal oopb•. Uaa <br />Peps ^_ of Porm 10 far mulllpl• vnfle ehenglnq from the •eme aDerator to the new op•reler Or <br />wnm Ne'Chanpe or Iran<portsr/GaNppr' on multlpla ralb pn fhe come. Thfa (orm fa net la Ee <br />utw for Wall Nem• changaa or etatu• ch•ngea. A saparat• PORM to must b• Lubmlaad fer <br />••eh nalu eompletlon end a FORM 70 for eaU produelnp lermatlen of ^ Mulllpl• Cempl•8on. It IL <br />the Oparatofa reapontibiliry to mail approved caDlea to Ina new Treneponer and/or Gatherer (or <br />eacn wall Il.tad. <br />pA1D <br />Gx.flo. <br />arc sa ~sss <br />oe .• <br />Operator Bond 8t+1 <br />© Blanket <br />^ Indlvldual <br />® Change of Operator Q Change o(Trnn~portar or Gatherer <br />Ena<tive Data: EHactlva Data: <br />Complato Tnla SacLOn For a Now orlndlvldua! Wall. <br />OCCC YY No; P NumpeC <br />D.S- <br />1Vee Neme Ntl NumYf. eb Neme en Numtac <br />LavBon lOwb, Bee, Twp, Rne, Meddlan): ~ AarY n Lour. <br />Mlel A6Yprlepb WeO 9Weup <br />L.ytlp..m ReyYlY GVavr: FY <br />FWenl aY{• <br />Indlsn elL(e. P•eYal er 4fYN <br />LseY Na <br />WB~eI Water OlsppW <br />F.Wry vwa Pe Numt.r. ~ Cenuet Pe <br />On.aee PB GamrtrlOW Pp <br />Ir~adbn WY NA <br />prydUrlnp F<rmsCen(s): Ra['emdeppni <br />Cwenl WY Stalu•: INb $nN In a ProdueEOn RYUm•0: <br />LIu1 om w.u LYYi <br />N Y II yae. Inlereele moat b woman. <br />If eanuq GGCC Wu, lean ne: <br />L <br />OIL TRANBPORTER OA6 GATHERER <br />Hams e(W iransw(v OGCC CpMlar He. Hama M Gas GetNro OGCC Opnta Ho. <br />Aooru. aaLe.. <br />Gar +reu rlp Clry el•le : 21p <br />ba • • um r <br />( 1 tle r n emu as • r e • e Wa TNS rormaYVn <br />I ) <br />!1 MulflPla Tnn+POrtar or OaNenr, ComPl+t+ W+ F6llowlny: <br />OIL TRANf PORTI•A W1E OATHERGR <br />Nam. el OY [nropenr OOCC OperLL> o. Nam• el OY OaIM(Y 00 O W oar Ne. <br />Add,.Y Aeenu <br />eh 9Gle p [q aW 0 <br />N.. em. rmn. Numeer vue d rp.e rlvmrtwn TN• ronrWbn <br />1 7 NY Vee• rndr Nlanb•r ow a rust a•r• TNa romuean <br />( ) <br /> <br /> <br /> <br /> <br />mu W rsq.ae eanab Ptl N. No .~<..ev414q. ei M. 01 an• Ou r--wnlan xomN..lr, H to Lou M 4mN lue 1.Y aaaWa• qtr. aaesn ss <br />.w..d .bo.. m1 N.. N. 4M.MMJ b IrJ rv~M1Slad u.r.n.a J.. M MYIr yu rWUwI IT Yu bw. •~~auJ wt •ti Baal .Fla rvN/Y.rW rYl b <br />ra~b ume ~uur nsrW a m< ve.eee+r nunY arch a ume „_ -.~Y •. W eelveee 01 W ee<eene dv. meanaaYw. <br />BWsr or OUeNiGpn a0 wre <br />Hama of Canbr a pare <br />$ rood 011 Pro [ias, Inc. 8aein Rac ices. Int. <br />TNe oats Tnla Gale <br />?resident / 12/1y6/~96 property lfanager <br />~y . J . ~Lw.c-yc.+_ry <br />GCC ADPrwee' ./~ Ta••~-- errt[e~en D°'p•~=-~: i99f~- <br />oac~,..rnn <br />P. 4 <br />E%HIBIT 31-73 <br />