Department of Geology and Mineral Industries s1

APPLICATION TO DRILL OIL OR GAS 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 520.) (1) Permittee Information (2) Well Information 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 OIL OR GAS WELL STATE OF OREGON  DEPT OF GEOLOGY & MINERAL INDUSTRIES  229 BROADALBIN ST SW  ALBANY OR 97321

0602973ecc417befa1a185d6fdf581e4.doc REV. 09-28-09 (In compliance with rules and regulations pursuant to ORS 520.)

REQUIREMENTS A complete application is required to obtain a permit to drill an oil or gas well.

A complete application consists of:

1. This completed application form. We must have original signatures for our records. 2. The $2,000 application fee. 3. A drilling bond. 4. Evidence of mineral rights ownership or lease.

PLEASE SUBMIT ONE ORIGINAL OF EACH DOCUMENT AND ONE ELECTRONIC COPY (VIA EMAIL OR DISK) OF EACH DOCUMENT.

The application will be reviewed to determine if it is required to be circulated to other agencies for review.

OAR 632-010-0010(6)(a) states that the State Geologist shall circulate each application for a permit to drill for technical review to appropriate state agencies and the governing body of the county or city in which the well will be located. The agencies and governing body have twenty (20) days from the date of application in which to comment; (b) The State Geologist may approve immediately without circulating for technical review an application for a permit to redrill, deepen, or rework if operations are an uninterrupted continuance of previous operations, provided conditions of OAR 632-010-0142(3) are met.

The permit will be issued after completion of the review process, if a review is required, otherwise the permit may be issued immediately.

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

Section 1 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 6 This information is confidential per ORS 520.095(2):

To compel the filing of logs, including electrical logs, if any are taken, drilling records, typical drill cuttings or cores, if cores are taken, in the office of the State Geologist within 20 days from the date of completion or abandonment of any well. For a period of two years from the date of abandonment or completion, such logs or other records or drill cuttings or cores shall be kept confidential and shall not be accessible to public inspection. However, the two-year confidentiality period may be extended for such time as the State Geologist determines is necessary for the reasonable protection of the economic interests of the person who has engaged in the drilling activity.

0602973ecc417befa1a185d6fdf581e4.doc REV. 09-28-09