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<br />• ~AlL Qt <br />FORM State of Colorado <br />2 COIOVAPO <br />Rev 12105 Oil and Gas Conservation Commission <br />1120 Lincoln Street, Suite 801, Denver, Colorado 80203 Phone: (303)8942100 Faz:(303)8942109 <br />APPLICATION FOR PERMIT TO: ~ °%as <br />®Drill, ~ Deepen, ~ Re-enter, ~ Recomplete and Operate <br />Ob'ective Formations Formation Code S acin Order Numbers Unit Acrea a Assi ned to Well Unit Confi uration N/2, SEl4, etc. <br />Dakota DKTA 499-15 320 W2 <br /> <br /> <br /> <br />21. Mineral Ownership: ®Fee estate Federal Indian Lease # <br />22. Surface Ownership: Fee State Federal Indian <br />23. Is the Surface Owner also the Mineral OwneR Yes No Surface Surety ID# 19990086 <br />23a. If 23 is Yes: Is the Surface Owner(s) signature on the Ieasel Yes ~No <br />23b. If 23 is No: Surface Owners Agreement Attached or $25,000 Blanket Surface Bond $2,000 Surface Bond ^$5,000 Surface Bond <br />24. Using standard OtrOtr, Sec, Twp, Rng format enter entire mineral lease description upon which this proposed wellsite is located (attach separate sheeUmap 'd you prefer): <br />S2 Sec. 25 T3N R64W <br />25. Distance to Nearest Mineral Lease Line: 470' 26. Total Acres in Lease: 320 _ <br />27. Is H2S anticipated? ~ Yes ~ No If Yes, attach contingency plan. <br />28. WII salt sections be encountered duing drilling? ~ Yes No <br />29. Will salt (>15,000 ppm TDS CI) or oil based muds be used during drilling? Yes ®No <br />29 or 30 are "Yes" a pit permit may be required. <br />? Yes No If 28 <br />l <br />903 <br />R <br />30. , <br />u <br />e <br />) <br />If questions 27 or 28 are yes, is this location in a sensitive area ( <br />31. Mud disposal: Offsite ~ Onsite <br /> Method: 8 Land Farming ~ Land Spreading ~ Disposal Facility ~ Other: <br />NOTE: The use of an earthen it for Recom letion fluids r wires a it ennit Rule 905b. If air/ as drillin , notify local fire officials. <br /> Strin Size of Hole Size of Casin Wei ht Per Foot Settin De th Sacks Cement Cement Bottom Cement To <br /> " 8 5/8" 24# 800` 575sx 800' Surface <br /> 4 1 /2" 10.5 7670' 7670' 5870' <br /> 2nd Sta a 350 lite 5870' 2000' <br /> <br /> <br />~ . Sta a Tool <br />32. ~ Annular Preventor ~ Double Ram ~ Rotating Head ~ None <br />BOP Equipment Type: <br />33. Comments Conductor Casin will not be used <br />34. Initial Rule 306 Consultation took place on (date) 12/4/07 ,was waived, or is not required. Provide supporting documentation if consultation , <br /> has been waived or if good faith effort did not result in consultation. <br /> PERMIT SUBMITTED TO COGCC PRIOR TO COMPLIANCE WITH RULE 306 CONSULTATION SHALL BE RETURNED UNAPPROVED. <br /> I hereby certify that a m lete permit package has been sent to the applicable Local Government Designee(s), and all statements made in this form are, <br /> to the best of my kno ed r e, rrect, and complete. <br />James Annable <br /> <br />e Print Name: <br />Signed: <br /> Title: Sr. Re ula Consultant Date: 12/13/07 Email: jim.annable comcast.net <br />Based on the information provided herein, this Appucanon ror rerm¢-to-unu compues wnn ~.ww r~uioa a~ ~~ aNN„~~,~ ~~..~~ ~ ~~ ~~ ~~ ~,.,,....~ `-rr----~ <br />COGCC Approved: <br />Director of COGCC Date: <br />Permit Number: Expiration Date: <br />API NUMBER CONDITIONS OF APPROVAL, IF ANY: <br />OS- <br />r ceee CDA!`INP_ ANn RAAI INr IN~ARMATIf1N <br />