Form Ogb-13 - Operator'S Certificate Of Compliance And Authorization To Transport Products From Plant

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STATE OIL AND GAS BOARD OF ALABAMA

OGB-13

Operator’s Certificate of Compliance and Authorization

to Transport Products from Plant

Form OGB-13, Rev. 07/13

(File in triplicate)

Name of plant ________________________________________________________ County ________________________________________

Operator _________________________________ Field ___________________________________ Number of wells_____________________

Address _____________________________________ City ___________________________ State ____________ Zip ________________

1. The above named operator hereby authorizes _______________________________________________________________________

(Name of Transporter)

Whose principal place of business is ____________________________ ____________________________ __________ ______________

(Street)

(City)

(State)

(Zip)

And whose field address is _________________________________________________________________________________________

To transport _________ % of the __________________________________ produced from the plant designated above until further notice.

(e.g. gasoline, butane, propane, sulfur)

Mode of transportation ________________________________________ Custody transfer point _____________________________________

(pipeline, truck)

(include meter point if applicable)

Other transporters transporting ____________________________________ from this plant are:

(e.g. gasoline, butane, propane, sulfur)

_______________________________________ _____________ %

______________________________________ ____________ %

(name of transporter)

2. Name of purchaser if different from transporter ______________________________________________________________________

Address _____________________________________ City ___________________________ State ____________ Zip ________________

3. Person to contact

Phone number

regarding this form

Fax number

E-mail address

Remarks:

The undersigned certifies that the above transporting agent is authorized to transport the above specified percentage of the products produced from the above

described plant in accordance with the State Oil and Gas Board of Alabama Administrative Code, and that this authorization will be valid until further notice or until

canceled by the Board, and the undersigned further certifies that the conservation laws of the State of Alabama and all rules, regulations, and orders of the Board

have been complied with in respect to the plant covered by this report.

__________

________

___________________________________________________

Executed this the _______ day of __________

, 20 __

Signature

________________________________________

Before me, the undersigned authority, on this day personally appeared

known to me to be the person

whose name is subscribed to the above instrument, who being by me duly sworn on oath states that he/she is duly authorized to make the above report and that

he/she has knowledge of the facts stated therein, and that said report is true and correct.

_______

______________________

_________

Subscribed and sworn to before me this

day of

, 20

_____________________________________

_____________________

Notary Public in and for

SEAL

________________________________