WELD COUNTY OIL AND GAS LOCATION ASSESSMENT (WOGLA) PROCEDURAL GUIDE SUBMITTAL CHECKLIST

WELD COUNTY OIL AND GAS LOCATION ASSESSMENT (WOGLA) PROCEDURAL GUIDE SUBMITTAL CHECKLIST APPLICATION REQUIREMENTS: One original application form Certification that a Surface Use Agreement (SUA) or other document, including, but not limited to, a Memorandum of SUA or an affidavit by the Applicant, has been executed by the operator and the surface owner(s) of the property where the oil and gas location will be located. If no SUA or other document is available at the time of applying for the WOGLA, the Applicant shall proceed with the WOGLA process and shall provide a statement that it is currently in SUA, or other agreement negotiations, and that it will bond onto the oil and gas location through the Colorado Oil and Gas Conservation Commission, or otherwise utilize its legal right of access as codified in C.R.S. 34-60-127. Certification that the Applicant has notified the owner(s) of building units located within 1,000 feet of the oil and gas location (as determined by Weld County Assessor s record at the time of notice), the Weld County Local Government Designee (LGD), and LGD s for municipalities located within 1,000 feet of the oil and gas location and has met with those notice recipients who have requested consultation. One copy of the drawing - see attached page for drawing requirements One copy of the questionnaire One copy of certified list of the names, addresses and the corresponding parcel identification number assigned by the Weld County Assessor of the building unit owners of property (the surface estate) within one thousand feet of the oil and gas location. This list shall be compiled from the records of the Weld County Assessor, the Weld County Website, www.co.weld.co.us or a person qualified to do the task, and shall be current as of a date no more than thirty days prior to the date the application is submitted to the Department of Planning Services. One legible copy of the deed or legal instrument by which the applicant obtained an interest in the property. Where an authorized legal agent signs the application for the oil and gas facility on behalf of the Applicant, evidence of a power of attorney or other authorization for the signature of the legal agent must be provided. An Improvements Agreement, if applicable A copy of the Weld County Emergency Action Plan or evidence it s not required by the Weld County Office of Emergency Management Flood Hazard Development Permit (FHDP), if applicable One digital or electronic copy of completed application materials, if required Application fee Investigation fee, if required (fifty percent of permit fee) The applicant shall submit 1 packet containing one original of all of the above for a 7 day completeness review. The packet shall be bound with either paper clips or binder clips (no substitutes). Applications bound in any other fashion may be returned to the applicant without review. Updated 1/2017

WELD COUNTY OIL AND GAS LOCATION ASSESSMENT (WOGLA) PROCEDURAL GUIDE APPLICATION FEE HEARINGS/MEETINGS PROCESSING TIME $ 500.00 Administrative Approval 45 days Planning Services may defer the WOGLA to the Board of County Commissioners for action Additional 45 days* Fees are non-refundable and due at time of application submittal. Fees are set by the Board of County Commissioners by Resolution. County Staff is not authorized to negotiate fees and cannot, under any circumstance, change, reduce, or amend the fees set forth in the Weld County Planning Fee Schedule. * This date may go beyond 45 days depending on scheduling a hearing with the Board of County Commissioners. PURPOSE The purpose of this packet is to provide information to the applicant regarding Weld County s Oil and Gas Location Assessment (WOGLA) for oil and gas facilities. INTENT AND APPLICABILITY The purpose of this packet is to provide general information to an applicant about the Weld County s Oil and Gas Location Assessment (WOGLA) application process. It is not intended to be a substitute for the specific requirements of Weld County Code, Chapter 23, Article II, Division 10. It is the responsibility of the applicant to be knowledgeable of the specific requirements of the Weld County Code, Chapter 23, Article II, Division 10, for the Weld County s Oil and Gas Location Assessment (WOGLA) application process. Weld County s Oil and Gas Location Assessment (WOGLA) are uses which have been determined to be more intense or to have a potentially greater Impact. Therefore, Weld County s Oil and Gas Location Assessment (WOGLA) require additional consideration to ensure that they are established and operated in a manner that is compatible with existing and planned land uses in the neighborhood. The additional consideration of Weld County s Oil and Gas Location Assessment (WOGLA) is designed to protect and promote the health, safety, convenience, and general welfare of the present and future residents of Weld County. The Department of Planning Services is responsible for reviewing and processing the application in accordance with Sections 23-2-1010 and 23-2-1020 of the Weld County Code. If determined by the Planning Director the Board of County Commissioners will consider the application in accordance with Section 23-2-1030 of the Weld County Code. It is recommended that the applicant attend all hearings scheduled for consideration of the application in order to present the proposal and answer any questions. The applicant is also encouraged to communicate with the Planning Department staff assigned to process and review the application once it has been submitted in order to keep up to date with any developments pertaining to the application. PRE-APPLICATION CONFERENCE Upon the Applicant s or Planning Director s request, made either before or after the submittal of the application, there may be an application meeting between the Applicant and the Department of Planning Services, which may be accomplished through a face-to-face meeting, electronic mail exchange, or conference call, as determined by the Department of Planning Services. The purpose of the application meeting is to give the Applicant an opportunity to demonstrate, through written and graphic information, how the OIL AND GAS FACILITY complies with the standards set forth in the Weld County Code.

APPLICATION REQUIREMENTS: It is the responsibility of the applicant to meet the application requirements outlined in Sections 23-2-1010 and 23-2-1020 of the Weld County Code. No WOGLA application shall be assigned a case number to be reviewed until all required items on the WOGLA submittal checklist have been completed and submitted to the Department of Planning Services. SIGN POSTING If a public hearing is required the Applicant will be responsible for posting a sign on the property under consideration in a location readily visible from the adjacent roadway(s). The sign will be posted at least ten days preceding the hearing date, with the Board of County Commissioners'. The sign will be posted adjacent to and visible from a publicly maintained road right-of-way. In the event the property under consideration is not adjacent to a publicly maintained road right-ofway, second sign at the point at which the driveway (access drive) intersects a publicly maintained road right-of-way will be posted. Evidence that the Applicant posted the sign shall be provided to the Department of Planning Services. INVESTIGATION FEE An additional fifty percent of the fee shall be added to the cost of the WOGLA application fee when the use is started without a WOGLA. The payment of the investigation fee shall not relieve any persons from fully complying with the requirements of the Weld County Code, Chapter 23, nor from any other penalties.

CONTACT INFORMATION AND OFFICE LOCATIONS Weld County Planning and Zoning Weld County Department of Public Works Planning Access Permits Floodplain Administration Engineering 1555 N. 17 th Avenue 1111 H Street Greeley CO 80631 Greeley CO 80631 (970) 400-6100 (970) 400-3750 www.weldgov.com/departments/public_works www.weldgov.com/departments/planning_and_zoning Colorado Dept. of Transportation 10601 W. 10 th Street Weld County Building Inspection Greeley CO 80634 Building Permits (970) 353-1232 Department of Planning 1555 N. 17 th Avenue www.codot.gov Greeley CO 80631 (970) 400-6100 Weld County Department of Public Health and Environment www.weldgov.com/departments/building Weld County Septic Permits On Site Waste Water Systems (OWTS) Division of Water Resources 1555 N 17 th Ave Water Wells Greeley CO 80631 1313 Sherman St (970) 304-6415 Room 818 Denver CO 80203 www.weldgov.com/departments/health_and_environment (303) 866-3581 Soil Conservation Districts 810 Ninth St Big Thompson (Fort Collins) - 970-493-1638 Second Floor Boulder Valley (Longmont) - 303-776-4034 Greeley CO 80631 Centennial - 970-522-7440 x3 (970) 352-8712 Fort Collins - 970-221-0611 Morgan - 970-867-9659 x3 www.water.state.co.us Platte Valley (Brighton) - 303-857-6721 Southeast Weld (Brighton) - 303-659-7004 x101 Well permitting information: West Adams (Brighton) - 303-659-2080 West Greeley - 970-356-8097 x3 www.dwr.state.co.us/wellpermitsearch/default.aspx www.coloradoacd.org Colorado Geological Survey Division of Minerals and Geology Colorado Department of Public Health and 1313 Sherman Street Environment Room 715 4300 Cherry Creek Drive South Denver CO 80203 Denver CO 80246 (303) 384-2643 (303) 692-2000 www.coloradogeologicalsurvey.org www.colorado.gov/cdphe

WELD COUNTY OIL AND GAS LOCATION ASSESSMENT (WOGLA) PROCEDURAL GUIDE FOR PLANNING DEPARTMENT USE DATE RECEIVED: _ RECEIPT # /AMOUNT # _/$ CASE # ASSIGNED: APPLICATION RECEIVED BY PLANNER ASSIGNED: Parcel Number(s) - - - - (12 digit number - found on Tax I.D. information, obtainable at the Weld County Assessor's Office, or www.co.weld.co.us) Legal Description of the Oil and Gas Location: Section, Township North, Range West Zone District:, Acreage of the Oil and Gas Location:, Flood Plain:, Geological Hazard:, Airport Overlay District:, MS4 Area:, Acreage of the Oil and Gas Facility:, Existing land use of the property where the Oil and Gas Location will be located: Provide the X and Y coordinates (Latitude and Longitude) of the proposed Oil and Gas Facility. Coordinates must be submitted as Decimal Degrees with precision to the fifth decimal place. (Example: 40.45113, - 104.69800): FEE OWNER(S) OF THE PROPERTY: Name: Work Phone # _Home Phone # Email Address: Address: City/State/Zip Code OPERATOR: Name: Work Phone # _Home Phone # Email Address: Address: City/State/Zip Code PROPOSED USE: I (We) hereby depose and state under penalties of perjury that all statements, proposals, and/or plans submitted with or contained within the application are true and correct to the best of my (our)knowledge. Signatures of all fee owners of property must sign this application unless an Authorized Agent signs and a letter of authorization from all fee owners is included with the application or an executed Surface Use Agreement is included with the application. If a corporation is the fee owner, notarized evidence must be included indicating that the signatory has to legal authority to sign for the corporation. Signature: Owner or Operator Date Signature: Owner or Operator Date

WELD COUNTY OIL AND GAS LOCATION ASSESSMENT (WOGLA) QUESTIONNAIRE The following questions are to be answered and submitted as part of the WOGLA application. If a question does not pertain to your use, please respond with not applicable, with an explanation as to why the question is not applicable. A. A statement which explains that the application complies with Article V and Article XI of Chapter 23 of the Weld County Code, if the proposal is located within any Overlay District Area or a Special Flood Hazard Area identified by maps officially adopted by the County. B. A statement which provides evidence of compliance with the following standards: 1. Oil and gas facilities shall be located to minimize impact on agricultural operations. 2. Dust control measures shall be employed as necessary during high traffic periods for both on-site and off-site haul roads, including unpaved county roads when necessary and in consultation with the county s Department of Public Works. 3. Traffic reduction measures shall be employed by operators when feasible: such as, utilizing fresh water supply pipelines for completions and the use of centralized storage facilities and/or transmission of crude oil via pipeline. 4. Haul routes shall be designated and developed in consultation with the county. Municipals, with roadways which are part of the haul routes, should be included in such consultation. 5. Liquid and solid wastes shall be stored and removed for final disposal in a manner that protects against surface and groundwater contamination. 6. The oil and gas facility shall comply with the Colorado Water Quality Control Commission regulations. 7. Noise from drilling, completion activities, and production shall comply with the Colorado Oil and Gas Conservation Commission Noise Control Regulation A-Scale Limits. 8. Light sources shall be shielded or directed downward, and in a manner to reduce impacts onto adjacent properties and dwellings. 9. Visual mitigation measures shall be considered and employed when feasible. 10. Site security measures shall be employed as necessary. 11. The oil and gas facility shall be maintained in such a manner to prevent noxious weeds. C. If applicable, a statement describing the size and approximate location of all oil and gas, and/or water pipelines, connecting to the oil and gas facility. D. A statement describing the kind of vehicles (type, size, weight) that will access the oil and gas facility during drilling and completion operations, and a defined access route. This shall include a traffic narrative with the following information: 1. The number of roundtrips/day expected for each vehicle type: Passenger Cars/Pickups, Tandem Trucks, Semi-Truck/Trailer/RV (Roundtrip=1 trip in and 1 trip out of site).

2. The expected travel routes or haul routes for the site traffic. 3. The travel distribution along the routes (e.g. 50% of traffic will come from the north, 20% from the south, 30% from the east, etc.). 4. The time of day when the highest traffic volumes are expected. A statement describing who will provide fire protection to the site. if the drilling waste (cuttings and fluids) will be disposed of on the oil and gas location, including a statement describing the location and disposal method.

WELD COUNTY OIL AND GAS LOCATION ASSESSMENT (WOGLA) DRAWING REQUIREMENTS DRAWING REQUIREMENTS: A final drawing showing the oil and gas facility and disturbed areas after collaboration with the property owner, building units located within 1,000 feet, the Weld County Local Government Designee (LGD), and LGD s for municipalities located within 1,000 feet through the WOGLA notice process. The drawing shall be a scaled drawing, or scaled aerial photograph showing the approximate outline of the oil and gas location and all wells and/or production facilities used for measuring distances. The drawing shall include all visible improvements within 1,000 feet of the proposed oil and gas location, with a horizontal distance and approximate bearing from the oil and gas facilities. Visible improvements shall include, but not be limited to, all buildings and properties, publicly maintained roads and trails, fences, above-ground utility lines, railroads, pipelines or pipeline markers, mines, oil wells, gas wells, injection wells, water wells known to the operator and those registered with the Colorado State Engineer, known springs, plugged wells, known sewers with manholes, standing bodies of water, and natural channels, including permanent canals and ditches through which water may flow. If there are no visible improvements within 1,000 feet of a proposed oil and gas location, it shall be so noted on the map. The Location Drawing shall also include the approved access(es) and proposed mitigation measures.

AFFIDAVIT OF INTEREST OWNERS SURFACE ESTATE Property Legal Description: Parcel Number - - - - (12 digit number - found on Tax I.D. information, obtainable at the Weld County Assessor's Office, or www.co.weld.co.us) (Include all lots being included in the application area, if additional space is required, attach an additional sheet) THE UNDERSIGNED, being first duly sworn, states that to the best of his or her knowledge the attached list is a true and accurate list of the names, addresses, and the corresponding Parcel Identification Number assigned by the Weld County Assessor of the owners of Building Units within one thousand feet of the oil and gas location. This list was compiled from the records of the Weld County Assessor, or a person qualified to do the task, and shall be current as of a date no more than thirty days prior to the date the application is submitted to the Department of Planning Services. Signatures of all fee owners of property must sign this application. If an Authorized Agent signs, a letter of authorization from all fee owners must be included with the application. If a corporation is the fee owner, notarized evidence must be included indicating the signatory has the legal authority to sign for the corporation. I (We) hereby depose and state under the penalties of perjury that all statements, proposals and/or plans submitted with or contained within the application are true and correct to the best of my (our) knowledge. Signature Date Signature Date Signature Date

Property Owner Weld County Public Works Dept. 1111 H Street P.O. Box 758 Greeley, CO 80632 Phone: (970)400-3750 Fax: (970)304-6497 Name Company Address_ City State Zip Phone Fax E-mail ACCESS PERMIT APPLICATION FORM Authorized Agent/Applicant (if different from Owner) Name Company Address City State _ Zip Phone Fax E-mail Parcel Location The access is on WCR Nearest Intersection: WCR & WCR Dist. from Intersection (approx. in ft.) Parcel Number(s) Section/Township/Range Total # of Existing Accesses to parcel Existing County Road Surface Information Asphalt Gravel Treated Other Proposed Access Information Culvert Size & Type (15 CMP/RCP min.) Materials used to construct access Access Construction Start Date Access Construction Finish Date Proposed Use Temporary (Tracking Pad Required) (#) Single Residential (#) Oil & Gas (#) Small Commercial (#) Large Commercial (#) Industrial (#) _ Field (Agriculture Only) (#)_ Subdivision (#) Is this access associated with a Planning or Building Department Process? USR/MUSR RECX/SUBX PUD WOGLA COMPLEX (IA required) Other Planning/Building Department case # Required Attached Documents - Traffic Control Plan (a generic plan can be found at https://www.weldgov.com/departments/public_works/permits/) During the review process it may be determined that a right-of-way use permit will be required as well. - Certificate of Insurance (with Weld County, Colorado listed as the certificate holder & as an additional insured) - Access Pictures (from the left, right, into & out of the access N, S, E, & W) - Access Authorization Form (Not required if the application is signed by the landowner.) Fee schedule (to be determined by permitting agency) - $75 each access point: Temporary, Small Commercial, Oil & Gas, Single Family Residential - $150 each access point: Industrial, Large Commercial, Subdivisions - Field (Agriculture only): no cost

Parcel Sketch (or provide an aerial on an add l sheet) = Existing Access = Proposed Access Description of Work or Reason for Permit By accepting this permit, the undersigned Property Owner/Authorized Agent, under penalty of perjury, verifies they have received all pages of the permit application; they have read and understand all the permit requirements and provisions set forth on all pages. By virtue of their signature the Property Owner/Authorized Agent is bound by and agrees to comply with all said permit requirements and provisions, all Weld County ordinances, and state laws regarding access construction. Signature_ Printed Name Date Signature_ Printed Name Date (In case of multiple Property Owners/Authorized Agents) Access Permits are good for 1 year from the date of issuance. Property Owner/Authorized Agent must obtain a new permit or request an extension if the construction of the access point is not completed in that timeframe. Extensions are subject to approval by Public Works County regulations on road access can be found in Article V of Chapter 12 of the Weld County Code.

CERTIFICATION OF SURFACE USE AGREEMENT (SUA) I (We) hereby certify, under penalty of perjury that the below stated information is true and correct to the best of my knowledge. I (We) have a Surface Use Agreement (SUA) or other document, including, but not limited to, a Memorandum of SUA or an affidavit by the Applicant, has been executed by the operator and the surface owner(s) of the property where the oil and gas location will be located. I affirm and acknowledge that the above statement is true and correct. Signature Signature Subscribed and sworn to before me this day of _, 20. My commission expires Notary Public OR If no SUA or other document is available at the time of applying for the WOGLA, the Applicant shall provide a statement that it is currently in SUA, or other agreement negotiations, and that it will bond onto the oil and gas location through the Colorado Oil and Gas Conservation Commission, or otherwise utilize its legal right of access as codified in C.R.S. 34-60-127. Statement: I affirm and acknowledge that the above statement is true and correct. Signature Signature Subscribed and sworn to before me this day of _, 20. My commission expires Notary Public

CERTIFICATION OF NOTICE TO BUILING UNITS WITHIN 1,000 FEET, WELD COUNTY LOCAL GOVERNMENT DESIGNEE (LGD), AND LGD S FOR MUNICIPALITIES LOCATED WITHIN 1,000 FEET OF THE OIL AND GAS LOCATION I (We) hereby certify, under penalty of perjury and after carefully reading the entire contents of this document, that the below stated information is true and correct to the best of my knowledge. I (We) have notified the owner(s) of building units located within 1,000 feet of the oil and gas location (as determined by Weld County Assessor s record at the time of notice), the Weld County Local Government Designee (LGD), and LGD s for municipalities located within 1,000 feet of the oil and gas location and have met with those notice recipients who have requested consultation. I affirm and acknowledge that the above statement is true and correct. Signature Signature Subscribed and sworn to before me this day of _, 20. My commission expires Notary Public

DEPARTMENT OF PLANNING AND BUILDING DEPARTMENT OF PUBLIC HEALTH AND ENVIRONNMENT 1555 NORTH 17 TH AVENUE GREELEY, CO 80631 AUTHORIZATION FORM FOR BUILDING, PLANNING AND HEALTH DEPARTMENT PERMITS AND SERVICES I, (We),, give permission to (Owner please print) (Applicant/Agent please print) to apply for any Planning, Building or Health Department permits or services on our behalf, for the property located at: _ Legal Description: of Section _, Township_N, RangeW Subdivision Name: Lot Block Property Owners Information: Phone: E-mail: Applicant/Agent Contact Information: Phone: E-Mail: Email correspondence to be sent to: Owner _ Applicant/Agent _Both_ Postal service correspondence to be sent to: (choose only one) Owner _ Applicant/Agent _ Additional Info: _ Owner Signature: Date: Owner Signature: Date: