Department Of Geology And Mineral Industries

APPLICATION TO DRILL GEOTHERMAL PROSPECT WELL STATE OF OREGON  DEPT OF GEOLOGY & MINERAL INDUSTRIES  229 BROADALBIN ST SW  ALBANY OR 97321 (In compliance with rules and regulations pursuant to ORS 522.) (1) Permittee Information (2) Well Information (OR ATTACH “MULTIPLE WELLS” PAGE) Name County Mailing Address Lease City/State/Zip Well No. Telephone Location 1/4 S T R Fax Wildcat or Field Email Elevation Prepared by Lat/Long of Wellhead

On Site Contact Surveyed SHL coordinates; include BHL for directional wells Phone (day) Phone (night) Geologic Objective Other Proposed Depth

Signature Title Date

(3) Lease/Ownership (if other than applicant) Lessor (mineral owner) Surface Owner Lessee Name Mailing Address City/State/Zip Telephone Fax Email

(4) Proposed Well Design (use additional sheets if necessary) Weight Size of hole Size of Casing Grade/Type Depth Type and Amount of Cement (pounds per foot)

bbls. bbls. bbls. bbls.

(5) Slurry Design for each String (use additional sheets if necessary) Annulus HT. left Annulus HT. left Excess Density Excess Density String 1 height in casing String 2 height in casing Tail ft. ft. bbls. ppg. Tail ft. ft. bbls. ppg. Lead ft. ft. bbls. ppg. Lead ft. ft. bbls. ppg.

(6) Geologic Information - if known (use additional sheets if necessary) 1 at 2 at 3 at Assumed fracture gradient of rock vs. depth psi/ft ft. psi/ft ft. psi/ft ft. Pore gradient of rock vs. depth (if known) psi/ft ft. psi/ft ft. psi/ft ft.

APPLICATION TO DRILL GEOTHERMAL PROSPECT WELL STATE OF OREGON  DEPT OF GEOLOGY & MINERAL INDUSTRIES  229 BROADALBIN ST SW  ALBANY OR 97321

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REQUIREMENTS A prospect well includes any well drilled as a geophysical test well, seismic shot hole, mineral exploration drilling, core drilling or temperature gradient test well, less than 2,000 feet in depth, and drilled in prospecting for geothermal resources.

A complete application is required to obtain a permit to drill a geothermal well. Up to FIVE wells may be covered by one permit (only one fee is charged).

A complete application consists of:

1. This completed application form. We must have original signatures for our records. Include an electronic copy of the completed application materials either via email or include a disk. 2. The $1,000 application fee. 3. A $10,000 bond or security, per hole. 4. Evidence of mineral rights ownership or lease.

APPLICATION FORM The application is generally self-explanatory. Clarifying notes are listed below:

Section 1 Permittee Information If the applicant is other than an individual, the entity must be registered to do business in Oregon if required by the Secretary of State’s office. Secretary of State’s web site: http://www.sos.state.or.us/.

Section 2 Well Information If multiple wells will be covered by one permit and the information in Sections 3-6 will be the same for all wells, use the included page “Multiple Wells” to list the information for each well. If the information in Sections 3-6 will be different for the wells, complete a separate application for each well.

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- - MULTIPLE WELLS - -

STATE OF OREGON  DEPT OF GEOLOGY & MINERAL INDUSTRIES  229 BROADALBIN ST SW  ALBANY OR 97321 (In compliance with rules and regulations pursuant to ORS 522.) (1) Permittee Information (2) Well Information

Location Surveyed SHL Well Geologic Proposed Coordinates. County Lease Lat/Long of Wildcat or Field Elev. Name/No. ¼ Objectives Depth Include BHL for Wellhead Section S T R directional wells

03b6718ae0b845c20ad5390d3c3364df.doc REV. 12/29/09