Analysis of the permitting processes associated with exploration of Federal OCS leases. Final report. Volume II. Appendices Page: 158 of 282
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EXHIBIT 4
No certificate may be issued DigitSequenci
unless a completed application A lietiao Ruat
form has been received (33 CFR 135.215).
y /.J
U. S. COAST GUARD
OUTER CONTINENTAL SELF LANDS ACT A&1EDMErTS OF 1978
FACILITY APPLICATION FOR CERTIFICATE Of FINANCIAL KESPONSI3ILITT1
2
3Ll fijII i I IIIIII i I III 1111ff ffIIII
Legal Name of ApPlicant
11111111I Trade Name ( If dif reI IAdd r es
4 1 f 1 !I I 1 1 1 1 dfrfas I I I i Wi. IJ.IJ.I.JI.I..I
S City State Z' Cad
Name of Contact Area Code Phone Number
6 I/We are filing for a Certificate of Financial Iesponsbility as:
7 1. Owner 2. Operator 3. Owner and Operator
3 4. Owner or Operator on behalf of two or more Owners or Operators
9 5. Froportional Owner or Operator(proportion of evidence submitted): J.J =
11 t/'e are providing evidence to cover the liability for each ownerr and operator
(named in appendix A to this application) of :he facillcy noted On this application.
11 I/we are filing for a Cartificate of F nanciallesponsibility for: I_
12 L.An initial facility(?roof of financial responsibility on back)
13 2.An additional facility(proof of financial responsibility was
1+ previously submitted in application number: I I
15 3.Change :o application or certificatee number: ! 1
16 The facility covered by this application is described as follows:
17 odu's,?latfors,Satellite wells,Underveter completions: o -all I I I
I ! Areailock Lease Field 1.D. Condensate I Other Oil
18 1 I i II 1
19 I I I I I I I I
20 . I i I i I 1 1 1
21 I I I I
22
23 p?.elies: from I to
Arew S1ock L2. J Area/ 3lockl L.J. Diameter I
2 _ I I ! I I I I I I I I
!Len ,h !i 3C a- a 7 0zher 011 1
25 1 ! ! I I
from T to
Areal 3Lock I L.J. Area/ 3locid 1.2. I Diameter
26 I e 1 1
S Lan th I e-.-- Other 1
27 1 I 1 i 1
from j to
Area 31ock I I.D. Areo/ 31ock 1.2. I Diameter
28 ! I I !
Length . MC ncelsa: 'tier -
29 I
Area 3lock Lease Field 1.D.
30
3: The desi nated J.S. agent for service of process is:32
I I I I I I I I 1 I I 1 I I I I I L I I
Name
331111II flllli1 1 1 11 1 III If IIff f f I f1 IIII
Address
34 1 1 1 1 1 1 1 1 11I I I I f I ..J.1 I... i... L.J...L .i
CIty State Zip Code
35 Signature:
36 Title/Dats:
37 I hereby certify the above information is correct to the best of my knowledge
and I agree to notify the Fund Administrator of any changes in the above
information:
38 Signature:
39 Title/Data:
C-7 ,. a.p
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Analysis of the permitting processes associated with exploration of Federal OCS leases. Final report. Volume II. Appendices, report, November 1, 1980; United States. (https://digital.library.unt.edu/ark:/67531/metadc1184664/m1/158/?rotate=90: accessed July 16, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.