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<br />Form 3160-3 <br />(April 2004) <br />UNITED STATES <br />DEPARTMENT OF THE INTERIOR <br />BUREAU OF LAND MANAGEMENT <br />APPLICATION FOR PERMIT TO DRILL OR REENTER <br />FORM APPROVED <br />OMB No. 1004-0137 <br />Expires March 31, 2007 <br />5. Lease Serial No. <br />C-0118327 <br />6. If Indian, Allotee or Tribe Name <br />NA <br />Ia. Type of work: ?? DRILL ? REENTER <br />lb. Type of Well: UOil Well U Gas Well <br />2. Name of Operator <br />Natural Soda, Inc. <br />7 it unit or ua tvgreemem, ivaluc Nlu v <br />White River Nahcolite <br />8. Lease Name and Well No. <br />Single Zone ? Multiple Zone 12H-C <br />3a. Address 3200 RBC 31, Rifle, Co 81650 I3b. Phone No. (include area <br />970-878-3674 <br />4. Location of Well (Report location clearly and in accordance with any State requirements *) <br />At surface Latitude: 39.929110'N Longitude: 108.351767'W <br />At proposed prod. zone Latitude: 39.929110'N Longitude: 108.351767'W <br />14. Distance in miles and direction from nearest town or post office* <br />- 45 miles southwest of Meeker Colorado <br />9. API Well No. <br />NA <br />10. Field and Pool, or Exploratory <br />Boies Bed <br />11, JGV., 1. iv ira. va uu+. w.» +. •-- • -? -- -- -- <br />TIS R98W Section 26 <br />12. County or Parish 13. State <br />Rio Blanco Co <br />15. Distance from proposed* -750 feet 16. No. of acres in lease 17. Spacing Unit dedicated to this well <br />location to nearest <br />property or lease line, ft. <br />Also to nearest drig. unit line, if any) 8222.6 <br /> <br />* <br />18. Distance from proposed location <br />19. Proposed Depth <br />20. BI M/B1A Bond No. on file <br />to nearest well, drilling, completed, _ 500' north of 10H-C <br />applied for, on this lease, ft. -2500 bgs 6149905 <br />Elevations (Show whether DF, KDB, RT, GL, etc.) <br />21 22 Approximate date work will start* 23. Estimated duration <br />. 05/1512009 Two Weeks <br /> 24. Attachments <br />The following, completed in accordance with the requirements of Onshore Oil and Gas Order No. 1, shall be attached to this form: <br /> Bond to cover the operations unless covered by an existing bond on file (see <br />4 <br />1. Well plat certified by a registered surveyor. . <br />Item 20 above). <br />2. A Drilling Plan. <br />3. A Surface Use Plan (if the location is on National Forest System Lands, the 5. Operator certification <br />cific information and/or plans as may be required by the <br />it <br />h <br />h <br />SUPO shall be filed with the appropriate Forest Service Office). e <br />e <br />er s <br />ot <br />6. Suc <br />e <br /> r <br />authorized <br />offic <br /> Name (PrintedlTyped) Date <br />25. Signature <br />C Bob Warneke 03/18/2009 <br />Title <br />Director of Mann cturing <br />Approved by (Signature) Name (Printed l yped) Date <br />Title I Office <br />Application approval does not warrantor certify that the applicant holds legal or equitable title to those rights in the subject lease which would entitle the applicant to <br />conduct operations thereon. <br />Conditions of approval, if any, are attached. <br />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 <br />States any false, fictitious or fraudulent statements or representations as to any matter within its jurisdiction. <br />*(Instructions on page 2)