| Engineer | Form: (02)
400388921
03/18/2013 | (1) COMPLIANCE WITH THE MOST CURRENT REVISION OF THE NORTHWEST COLORADO NOTIFICATION POLICY IS REQUIRED.
(2) APPROVAL OF THIS FORM DOES NOT AUTHORIZE INJECTION. AUTHORIZATION TO INJECT REQUIRES APPROVAL OF FORM 31 AND FORM 33.
(3) BEFORE STIMULATING THE WELL, CAPTURE A WATER SAMPLE FROM the FORMATION(S) REQUESTED FOR INJECTION] AND ANALYZE FOR TOTAL DISSOLVED SOLIDS. SUBMIT LAB ANALYSIS TO DENISE.ONYSKIW@STATE.CO.US
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