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18 SITE PLAN SOUTH LEVERICH 18-13 PAD OPERATOR: LARAMIE ENERGY II GOVT LOT 4 SECTION 18 T7S R93W 6th PM GARFIELD COUNTY, COLORADO Vicinity Map 1"=2000' EMERGENCY CONTACT INFORMATION:
1) Laramie Energy II, LLC 24 HR. Emergency Contact (800) 891-6191 2) Randy Natvig -Drilling Manager Laramie Energy II, LLC 1512 Larimer Street, Suite 1000 Denver, CO 80202 W. (303) 339-4337
C. (303) 478-5191 3) Bob Hea -V.P. Operations Laramie Energy II, LLC 1512 Larimer Street, Suite 1000 Denver, CO 80202 W. (303) 339-4925 C. (303) 842-4982 4) Wayne P. Bankert -Senior
Regulatory & Environmental Coordinator Laramie Energy II, LLC 301 28 1/4 Rd. Suite D Grand Junction, CO 81506 W. (970) 683-5419 C. (970) 985-5383 5) Garfield County Dispatch (970) 625-8095
6) St. Mary's CareFlight Helicopter (970) 332-4923 7) Poison Control Hotline (800) 222-1222 8) CHEMTREC (800) 424-9300 0 50 100 Graphic Scale in Feet 1" = 50' SURFACE OWNERSHIP: Gordman
Leverich, LLP 1005 Waters Avenue Aspen, CO, 81611 (970) 925 5400 DRIVING DIRECTIONS: MP 0.0 -Roundabout at Airport Rd and Taughenbaugh Blvd on the south side of I-70 exit 90; West through
roundabout along S 7th St MP 0.2 -End S 7th St /begin CR 320, aka Rifle Rullison Rd, sharp left hand turn onto CR 320 South along CR 320 MP 0.5 -Sharp right hand turn on CR 320 West
along CR 320 MP 2.3 -Top of switchback bear left /intersection with CR 320 and CR 321 Continue west on CR 320 MP 3.0 -Bear left onto CR 317, aka Beaver Creek Road, leave CR 320, end
asphalt, begin gravel surface Southerly along CR 317 MP 3.9 -Unnamed gravel road bears left Continue southerly along CR 317 MP 5.1 -Access to City of Rifle Water Intake bears right MP
5.3 -Driveway to Lucky 7 ranch bears right MP 6.5 -Unnamed gravel road /Encana access bears right Continue southerly along CR 317 MP 8.3 -Bear left off CR 317 onto intersection with
Leverich Encana access road, an unnamed gravel road, leave CR 317. Locked gate combo Encana 2468 /Leverich 5158 Proceed easterly along gravel access road, up steep grade MP 9.0 -Access
to Leverich 13-09 pad MP 9.4 -Cross n-s fence /cattle guard MP 9.5 -Bear left onto access road to destination at Leverich 18-13 pad 277' to pad. INSTALLATION & REMOVAL DATES: Installation
Date: January 28, 2009 Removal Date: January 23 2010 Cumulative Time Onsite: 360 days
1 GARFIELD COUNTY Building and Planning Department 108 8th Street, Suite 401 Glenwood Springs, Colorado 81601 Telephone: (970) 945-8212 Facsimile: (970) 384-3470 www.garfield-county.com
Small Temporary Employee Housing Administrative Checklist GENERAL INFORMATION – Submit 1 paper & 1 CD copy of the completed application to Planning Department w/in 48 hours following
occupation (To be completed by the Small Facility Operator – e.g. well pad operator) Section/Township/Range Location of Housing Site: SWSW 18, 7S, 93W Well Pad Number: South Leverich
18-13 Tax Parcel Number for Parcel Containing Housing Site: 2403184000014 GPS and/or Lat-Long Coordinates of Housing Facility Site (Often included in APD): 39.434725N, 107.823853W Zone
District: R -Rural Maximum Number of Occupants at Permitted Site (e.g. well pad): 8 Cumulative Amount of Time (in Days) The Facility Will be at Location: 360 State or Federal Permitting
Agency Overseeing Reclamation, Restoration and Revegetation and Relevant Permit Number: COGCC – APD# 20085727 Date of Installation: 01/28/2009 Date of Removal: 01/23/2010 Name of Landowner:
Gordman Leverich, LLP Street Address: 1005 Waters Avenue Telephone: (970) 925-8559 Email: City: Aspen State: CO Zip Code: 81611 Name of Operator’s Compliance Officer: Wayne Bankert Street
Address: 601 28 ¼ Road Telephone: (970) 683-5419 Email: wbankert@laramie-energy.com City: Grand Junction State: CO Zip Code: 81506 Company 24-Hour Emergency Contact: Randy Natvig Phone
Number: 800-891-6191 This Administrative Checklist must be received by the Garfield County Planning Department within 48 hours following occupancy of the Small Facility. A copy of this
completed Administrative Checklist and all associated submittals shall be delivered to the Garfield County Sheriff’s Office and relevant Fire Protection District (if applicable) within
48 hours following occupancy of the Small Facility. Additionally, the Garfield County Sheriff’s Office and relevant Fire Protection District (if applicable) must be notified in writing
(return receipt) or verified email (return receipt) within 48 hours following removal of the Small Facility. It is the Operator’s responsibility to confirm and obtain verification that
the Administrative Checklist has been received by 240318400014
2 the Sheriff’s Office and Fire Protection District. Fire Suppression Requirements (Per Performance Standard L) “A water storage tank is required to provide water to the sprinkler system
(if applicable) and initial suppression activities. The size of the water tank shall be determined based on sprinkler calculations and initial suppression demands. The relevant fire
protection district shall be responsible for determining the size of the water storage tank. If the Small Facility is not within a fire protection district, the Operator shall provide
at least 2500 gallons of water dedicated to initial fire suppression which is accessible with a dry hydrant.” Required Size of water storage tank for sprinkler system and initial suppression
activities: _________2,500___________ gallons A. Outline of Process. The Small Temporary Housing Facility(ies) Review process shall consist of the following procedures as more fully
outlined in Section 4-109 of Article IV of the Unified Land Use Resolution of 2008. 1. Application to relevant protection districts and the Garfield County Sheriff’s Office. 2. Application
to the County B. Review Process. Prior to submittal of any forms to the Planning Department, the applicant shall submit all documents to the relevant fire protection district(s) and
the Garfield County Sheriff’s Office. All forms shall be accurately completed, signed, dated and submitted to the Garfield County Planning Department within 48 hours following occupation
of the Small Facility. C. Submittal Requirements. The application submitted to the County shall contain the following information: i. A vicinity map indicating the section, township,
and range of the subject lot and the location of Small Facility within the subject lot and the Permitted Site; general relation to surrounding public roads, private roads, adjacent utility
systems, residential development, other actively permitted Small, Minor and Major Facilities, natural drainage courses and municipalities within one (1) mile of the proposed Small Facility;
north arrow and scale; GPS coordinates and current surface ownership of the subject lot. The vicinity map shall be presented on a USGS 7.5 minute series quadrangle at a scale of 1”=2000’
or equivalent, with a topography depicted at a minimum of 40’ intervals. ii. Surveyed layout of the proposed Small Facility within the surveyed boundaries of the Permitted Site, including
at a minimum: sewage and wastewater disposal, trash receptacles, potable water storage, all other associated infrastructure and all other equipment located within the Permitted Site.
(See Section 4-502 (C )(3) for site plan definition) iii. Identification of the private and public roadways accessing each Small Facility. Roadways shall be marked as open, gated, and/or
locked (include combinations). Detailed directions, with mileage, shall be given from the nearest town within Garfield County, nearest Garfield County Sheriff’s Office dispatch location
and responsible fire district headquarters to each Small Facility, along each roadway. iv. Name, address and phone number of surface owner of the subject lot. v. Name, address and phone
number, including a 24-hour emergency response number of at least two persons responsible for Operator’s emergency field
3 operations; contact numbers for local hospitals, emergency response, fire protection districts, Garfield County Sheriff’s Office, Life/Care Flight, and applicable regulatory agencies;
site safety/evacuation plan; and any other written response plan for potential emergencies at the Permitted Site. vi. Identification of the anticipated dates of installation and removal
of the Small Facility. The site plan shall include a notation of the total cumulative length of time (number of days) that the Small Facility will be installed at the Permitted Site.
ELIGIBILITY Requirement (Section 7-808 (D)(3) – All Requirements Must be Satisfied to be Eligible as a Small Facility Applicant Planning Department Complies (Y/N) Complies (Y/N) The
Small Facility and any associated infrastructure must be completely contained within a state or federally permitted parcel (such as a Colorado Oil and Gas Conservation Commission (COGCC)
approved oil/gas well pad) in which reclamation and revegetation are secured with the permitting agency (Permitted Site); and, Yes The Small Facility is located at the Permitted Site
for less than a cumulative of one (1) year and at the end of the utilization period, all structures, foundations and associated infrastructure are completely removed; and, Yes The Small
Facility shall have an occupancy of eight (8) or fewer people within a Permitted Site (e.g. well pad) who are employees, contractors or sub-contractors of the operator of the small facility
and are needed for onsite safety of the related commercial, industrial, extraction or highway operation. Temporary employee housing facilities that do not have the three characteristics
listed above, or consist wholly or in part of Recreational Vehicles as defined above, are subject to the administrative permit requirements or the Major Impact Permit process, standards
and requirements contained in this document. Yes
4 Building Information (Per Unit) Unit 1 Make: ATCO Serial Number or Unit ID Number: Clyde 20563 Manufacture Year: 2006 Size of Unit (Square Feet): 13x58 – 754 sq ft. Unit 2 Make: ATCO
Serial Number or Unit ID Number: Sneezy 19077 Manufacture Year: 2008 Size of Unit (Square Feet): 13x54 – 702 sq ft. Unit 3 Make: ATCO Serial Number or Unit ID Number: Tool Pusher 354052702
Manufacture Year: 2005 Size of Unit (Square Feet): 13x54 – 702 sq ft. Unit 4 Make: Serial Number or Unit ID Number: Manufacture Year: Size of Unit (Square Feet): Unit 5 Make: Serial
Number or Unit ID Number: Manufacture Year: Size of Unit (Square Feet): ISDS Permit ISDS Permit Number: Signature of Operator’s Compliance Officer:_______________________________________________
( By signing this form, I verify that all information provided in this checklist is correct and accurate to the best of my knowledge) Print Name: Wayne Bankert____________________ Title:
Senior Reg. & Env. Coordinator Wayne P. Bankert Digitally signed by Wayne P. Bankert DN: cn=Wayne P. Bankert, o=Laramie Energy II, LLC, ou, email=wbankert@laramie-energy. com, c=US Date:
2009.01.23 09:30:25 -07'00'
5 Eligibility, Submittal and Performance Standards Certification Section 7-808(D)(3) -Small Temporary Employee Housing Facilities (Small Facility(ies)) in Article VII – Standards, requires
the that the following performance standards be met with each facility: Small Facilities, in the nature of Factory Built Nonresidential Structures [as defined under C.R.S. 24-32-3302(a)]
but NOT recreational vehicles [as defined under C.R.S. 42-1-102 (61), including truck, truck tractor, motor home or camper trailer], may be utilized for housing of workers on projects
related to commercial, industrial, mineral extraction or highway operations, pursuant to the standards for Small Facilities contained in subsection (2), below. Such facilities are not
subject to Garfield County building and fire codes (building code, fire code). However, Small Facilities are subject to all pertinent state (i.e. electrical permits), federal permits
and relevant fire protection district(s) code requirements. Small Facilities shall have all of the following basic characteristics: A. The Small Facility and any associated infrastructure
must be completely contained within a state or federally permitted parcel (such as a Colorado Oil and Gas Conservation Commission (COGCC) approved oil/gas well pad) in which reclamation
and revegetation are secured with the permitting agency (Permitted Site); and, B. The Small Facility is located at the Permitted Site for less than a cumulative of one (1) year and at
the end of the utilization period, all structures, foundations and associated infrastructure are completely removed; and, C. The Small Facility shall have an occupancy of eight (8) or
fewer people who are employees, contractors or sub-contractors of the operator of the small facility and are needed for onsite safety of the related commercial, industrial, extraction
or highway operation. Temporary employee housing facilities that do not have the three characteristics listed above, or consist wholly or in part of Recreational Vehicles as defined
above, are subject to the administrative permit requirements or the Major Impact permit process, standards and requirements contained in this document. The Small Facility shall adhere
to the following Standards: All required submittals (as outlined in (2), above) shall be submitted to the Planning Department within 48 hours following occupation of the Small Facility.
Enforcement shall be in accordance with this Resolution. The Small Facility shall demonstrate and certify compliance with the following standards: A. Small Facility must comply with
all applicable federal, state and local laws and regulations. B. The Small Facility shall NOT contain recreational vehicles as defined in Section 7-808 (D). C. In no case shall unsafe
water be used for drinking nor shall raw sewage or contaminated water be discharged on the ground surface. The operator shall
6 conduct monthly tests (or quarterly if an on-site disinfection system is installed) and maintain records of stored potable water samples specific for coli form bacteria. Any tests
indicating coli form contamination must be disclosed to the Garfield County Board of Health or designee within 72 hours from the time the contaminated water was tested. D. Each Small
Facility shall be maintained in a clean, safe and sanitary condition, free of weeds and refuse. Any hazardous or noxious materials that must be stored at the Small Facility for operational
or security reasons must be managed in accordance with all applicable federal, state and local laws and regulations. E. At least one thirty (30) gallon (4 cubic feet) wildlife-proof
refuse container shall be provided for each Factory Built Non-Residential Structure unit. Said container(s) must be durable, washable, non-absorbent metal or plastic with tight-fitting
lids. F. Refuse shall be disposed of weekly, at a minimum. Operators must keep appropriate records, to be provided to the County or any interested third party upon request, to demonstrate
that refuse is collected in a timely fashion and disposed of at a licensed facility. G. Outdoor food storage is prohibited. H. Factory Built Non-Residential Structures equipped by the
manufacturer with a fire sprinkler system, fire detection system, and/or alarm system shall be inspected, tested, and maintained in accordance with the requirements of the relevant fire
protection district(s) and the Colorado Division of Housing. I. Single-station carbon monoxide alarms shall be placed in each Factory Built Non-Residential Structure. J. One (1) or more
approved fire extinguisher(s) of a type suitable for flammable liquids, combustible materials and electrical fires (Class ABC), or dry chemical, shall be located in each Factory Built
Non-Residential Structure and placed in accordance with applicable fire protection district and/or Colorado Division of Housing codes. K. Domestic animals are prohibited at all Small
Facilities. L. A water storage tank is required to provide water to the sprinkler system (if applicable) and initial suppression activities. The size of the water tank shall be determined
based on sprinkler calculations and initial suppression demands. The relevant fire protection district shall be responsible for determining the size of the water storage tank. If the
Small Facility is not within a fire protection district, the Operator shall provide at least 2500 gallons of water dedicated to initial fire suppression which is accessible with a dry
hydrant within each Permitted Site for a Small Facility. M. The operator shall document all emergency situations requiring action by any government agency or fire protection district,
in writing, and such documentation shall be presented to the Planning Department within 24 hours of the occurrence. N. All required Access Permits shall be obtained from the Garfield
County Road and Bridge Department or the Colorado Department of Transportation. O. The Garfield County Sheriff’s Office and relevant fire protection district(s) shall be notified and
provided with all documentation as outlined in these regulations, within
7 48 hours following occupation of each Small Facility. In addition, the Garfield County Sheriff’s Office and relevant fire protection district(s) shall be notified either by hard-copy
or electronically within 48 hours following removal of all Small Facilities. The Planning Department shall be copied on all such notification, whether hard copy or electronic. P. The
Operator shall maintain records identifying workers, whether employees, contractors or sub-contractors, and document the dates that each worker is housed at the Small Facility. Such
records shall be provided to the County or any additional third party upon request. Q. The Operator shall obtain a certification inspection conducted by a third-party Professional Engineer
Licensed in the State of Colorado. The certification shall verify that at the time of inspection the identified Small Facility meets or exceeds the standards set forth in Article 7.808
D. 2. of the Garfield County Land Use Code of 2008, as amended. This certification shall be on forms provided by the Garfield County Planning Department. The certification shall be provided
to the Garfield County Planning Department within 48 hours following occupation of the Small Facility. R. The Operator shall accurately complete all required forms provided by the Garfield
County Planning Department identifying the location of the facility (Section/Township/Range, relevant Tax Parcel Number, and GPS coordinates or Latitude/Longitude coordinates); relevant
zone district; maximum number of occupants; cumulative amount of time (in days) that the Small Facility will be at the specified location; identification of the State or Federal permitting
agency overseeing reclamation, rehabilitation and revegetation of the Permitted Site and relevant permit number; date of installation; date of removal; name and contact information of
the landowner; name and contact information of the Operator’s Compliance Officer; 24-hour emergency contact information for the Operator; building information (make, manufacture year,
serial number, size (square feet)); signature and contact information of the Operator’s Compliance Officer. S. Wastewater Disposal: 1) Vault System: All vault systems shall be designed
and installed to accommodate the maximum number of persons (eight or less individuals), who will inhabit the Small Facility. In addition, all vault systems shall be equipped with an
overflow alarm device. Vault systems shall be designed to accommodate a minimum of 75 gallons of wastewater per person per day. If a vault system is proposed or has been approved, the
Operator must: a. Demonstrate that year-round vehicular access is available and maintained for safe and regular access for sewage hauling vehicles. b. Maintain all sewage disposal records
including but not limited to trip logs/reports and landfill receipts as public records, available to the County and/or any other interested third party upon request. c. (b) Individual
Sewage Disposal System (ISDS): If an ISDS is proposed, then it shall be designed, installed and operated to accommodate the maximum number of persons who will inhabit the Small Facility
(eight or less individuals) and shall otherwise be permitted and
8 operated in accordance with the Garfield County ISDS regulations as contained in BOCC Resolution Number 1994H-136. I hereby attest that I am the designated Compliance Officer for the
aforementioned Small Temporary Employee Housing Facility(ies). I attest that I have read and understand the standards to which the Facility(ies) shall be installed and operated. I attest
that the Facility(ies) will be constructed and maintained in accordance with all applicable Garfield County, State of Colorado and Federal regulations and standards. In addition, I attest
that I have read and understand the enforcement provisions as described in Article 12 of the Garfield County Unified Land Use Resolution of 2008. Further, I understand that non-compliance
with any of the provisions as outlined in Article 7-808 (D) (3) of the Garfield County Unified Land Use Resolution of 2008 shall be enforced in accordance with Article 12. Signature
of Operator’s Compliance Officer:___________________________________ Print Name: Wayne P. Bankert Title: Senior Reg. & Env. Coordinator Phone Number: (970)683-5419 C: (970) 985-5383
Email: wbankert@laramie-energy.com I hereby attest that I am a Licensed Professional Engineer in the State of Colorado. I attest that I have conducted a visual inspection of the Small
Facility identified in this Administrative Checklist, as installed, and, based on information from that inspection I certify that the Small Facility complies with the standards set forth
in Article 7-808 (D) (3) of the Unified Land Use Resolution of 2008. PE Certification Number PE Stamp Date of Inspection Print Name and Title Signature Wayne P. Bankert Digitally signed
by Wayne P. Bankert DN: cn=Wayne P. Bankert, o=Laramie Energy II, LLC, ou, email=wbankert@laramie-energy. com, c=US Date: 2009.01.23 09:30:50 -07'00'
"/South Leverich 18-13 240318400014 240307300001 240513200088 240523100955 240319200028240317100952 240318400083 7 1 9 2 8 6 5 4 3 6 5 4 3 19 18 36 11 25 35 19 25 24 30 24 34 26 31 33
23 29 13 32 27 15 20 23 14 28 21 22 26 20 12 10 21 17 16 29 22 28 27 35 36 30 31 32 33 34 3 2 27 15 22 2 10 23 34 26 35 11 14 23 26 34 27 22 35 15 14 13 7S93W 7S94W 6S93W 6S94W 8S93W
UV32 0 UV317 UV319 UV325 UV321 UV334 UV357A UV357B Pad Location (not to scale) "/South Leverich 18-12B Existing Roads CountyRoads Parcels 240318400014 (area: 678 acres) Rifle, CO PROJECT
NO: DRAWN BY: DATE: 008-2319 LAB 01/20/09 ADJACENT PARCELS MAP SOUTH LEVERICH 18-13 PAD TEMPORARY HOUSING PERMIT LARAMIE ENERGY II, LLC GARFIELD COUNTY, COLORADO 826 21-1/2 ROAD GRAND
JUNCTION, CO 81505 TEL 970.263.7800 FAX 970.263.7456 FIGURE 1Ê 0 0.5 1 2Miles 1 inch equals 1 mile
"/South Leverich 18-137 1 9 2 8 6 5 4 3 6 5 4 3 19 18 36 11 25 35 19 25 24 30 24 34 26 31 33 23 29 13 32 27 15 20 23 14 28 21 22 26 20 12 10 21 17 16 29 22 28 27 35 36 30 31 32 33 34
3 2 27 15 22 2 10 23 34 26 35 11 14 23 26 34 27 22 35 15 14 13 7S93W 7S94W 6S93W 6S94W 8S93W UV32 0 UV317 UV319 UV325 UV321 UV334 UV357A UV357B Pad Location (not to scale) "/South Leverich
18-12B Existing Roads CountyRoads Rifle, CO PROJECT NO: DRAWN BY: DATE: 008-2319 LAB 01/20/09 VICINITY MAP SOUTH LEVERICH 18-13 PAD TEMPORARY HOUSING PERMIT LARAMIE ENERGY II, LLC GARFIELD
COUNTY, COLORADO 826 21-1/2 ROAD GRAND JUNCTION, CO 81505 TEL 970.263.7800 FAX 970.263.7456 FIGURE 1Ê 0 0.5 1 2Miles 1 inch equals 1 mile