APPLICATION FOR PERMIT TO DRILL OR RE-ENTERAPPLICATION TO DRILL I2S1 RE-ENTER OLD WELL C

NAME OF COMPANY OR OPERATOR

A/t~e r \c' t, lJ~~ fofasGAddress City State Phone Number

GOo r7+k Sired C;uvJe- Z SOD S -i)e~nJU C080102- 30:3-h3,1~"l-7-3fDrilling Contractor './-: -r '6co JSe..v...) CA.,{'

Address PD13v)'( 2.0b7 AC 1~Y1 NM 670 J- I

DESCRIPTION OF WELL AND LEASE

Federal, State or Indian Lease, ~mber, or if fee lease, name of lessor Well number I Eleva;on (~round) I

/J5t-1l D8-[;' 11g «(, -/7..-- '-' -,0 (P(S-{Nearest distance from proposed location to property or lease line: Distance from proposed location to nearset drilling, completed or applied-for

;J../32.' k Swell on the same lease:

~!I: J0(11-+}~/ N~ Y-,-N feet KG- if /°1000 feet

Number of licresU!' lease Number of wells on lease, including this well, completed in or drilling to this reservoir:

6{O IIf lease purchased with one or more wells Name Addressdrilled, from whom purchased,

'2 1'3'2.' f}/ .;l..'/S-~' -Ie (weillocatiollgi/~footage from section lines~ t( I(sec~ - Township - Ra4ge or Block and sri . I Dedicatio~P/~' R12-7-104(A)(3)/}</).' ~i "~M l ~;",,,- cft C~, Cr ?:,.ef- (1If5/J .u:Field and itlse~dir (if wildcat, so state) I County- ~~acheDistance in n:iles and ~rction 7,m nearest to~ or bast O~ir 1/

37 ,A..!I\'\(,s {'onl, '6trCJGProposed depth: Ll

Rotary 9!C~tttools APA~ate d7e work will start/!

ISOd f.- 7J of l1 PI I 'Z,O 7-0Bond status 49vt -C(~ Organization Reporf] Filing Fee of $25.00

Amount JjC;u,noo On file or~ A~

Remarks ~ I

[. 1) r i If, l.t).>C w; rE'o h) e. 10<9 (s1- . Ii- f1-1.. po (0 r '1 C« ~ ~ (;00 I

:3. C 0 r-« - (000 1.,/ /500 I

CERTIFICATE: I, the un~+signed, c:the penalty of perjury, state that I am the: he s(J (.1'( f of the

41',1\ C!, I Lo.JI LJQ ( '1~~s (company), and that I am authorized by said company to make this report; and that this

report was prepared under my supervision and direction and that the facts stated therein are true, correct and complete to the best of my knowledge.

41c/~yf/V!!l

API OJ.- -DO 1- ~o Lfo { Signature

if-L(- ;).~;I/Mail completed form to:Oil and Gas Program AdministratorArizona Geological Survey

Date416 W. Congress,#100Tucson,AZ 85701-1315

Permit Number: -----L~---.!L'i--------------.------..--.- STATE OF ARIZONAApproval Date: '1-1$'-(/ OIL & GAS CONSERVATION COMMISSION

Approved By: -----..---s::b..4?~ ....._._---_ .... - ..__ .-_._...- ..- Application to Drill or Re-enter

NOTICE: Before sending in this form be sure that you have ~iven all informationFile Two Copies

requested. Much unnecessary correspondence WI I thus be avoided.Form NO.3

(Complete Reverse Side) 5/96

1. Operator shall outline on the plat the acreage dedicated to the well in compliance with A.A.C. R12-7-107.

2. A registered surveyor shall show on the plat the location of the well and certify this information in the space provided.

: :L~:~:::::,E:,SO:::":i::::~:::~S:C::::::i:,:EO:~h:Ep:~~~:~'E~THESE::ON5. If the answer to question four is no, have the interests of all owners been consolidated by communitization agreement or otherwise?

YES __ NO __ If answer is yes, give type of consolidation .. .

6. If the answer to question four is no, list all the owners and their respective interests below:

Owner Land Description

I

I

I

I

I

I

I

I I

------------4--------------------------r-------------I

II

I

I

III

I

I

II

I

N34" $7~Z-&.,.3 "'Nw l()tt.].J' OO..5pI

t'/eY. ,/6-/,0' :I

.5Ic'

o 330 660 990 1320 1650 1980 2310 2640 2000 1500 500

CERTIFICATION

I hereby certify that the information abovis true and complete to the best of myknowledge and belief.

Name

Position

Company

Date

Size of Casing Weight Grade & Type Top Bottom Cementing Depths Sacks Cement Type

~'l ~rJ Ie ~{-I !lor» Q(fDX. o-,/tr C'I...Pfo., )/.~f'II- 171re~L 0 9ft 'Co.tcl.ut/or

1-f)-«{)

0-50" 500~

f& -U~ctb)~ CI6 ~J--:L .:]:A.-[ 1/ c. itS ,.}'J~

1000

PROPOSED CASING PROGRAM

I hereby certify that the well location shownon the plat was plotted from field notes ofactual surveys made by me or under mysupervision, and that the same is true andcorrect to the best of my knowledge andbelief.

ear/Registered Land Surveyor

O~~~~~~,~~~O~~-~--~22270