Directive 065: Resources Applications for Oil and Gas Reservoirs ...

DAY MONTH YEAR
Resources Applications - Schedule 1
Applicant General Information
APPLICATION #
APPLICANT'S FILE NUMBER
The applicant certifies that the information provided here and in all supporting documentation is correct and in
accordance with all regulatory requirements or as directed by the Energy Resources Conservation Board.
SUBMISSION STATUS SUBMISSION ID CREATION DATE
1. APPLICANT INFORMATION
COMPANY NAME
BA CODE
CONTACT NAME
TELEPHONE
FAX
E-MAIL
MAILING ADDRESS
2. APPLICATION TYPE
(For Electronic Submission purposes, Resources Applications only accepts one application type per submission)
APPLICATION DESCRIPTION
3. LOCATION (Minimum input Twp/Rg/Mer)
LE Lsd Sec Twp Rge Mer ES LE Lsd Sec Twp Rge Mer
ES
W
W
W
W
W
W
W
W
W
W
4. FIELD AND POOL LIST
Field Name
Pool Name
- -
5. OWNERSHIP AND NOTIFICATION INFORMATION
1.
What is the ownership basis on which you make this application?
2.
Has notification been conducted in accordance with the requirements for this application?
Yes
No
2a.
If no, do you need ERCB assistance to complete the notification requirements? Please explain. Yes
No
3.
Are there outstanding concerns? Yes (please explain)
Yes
No