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Railroad Commission of Texas

July 2004

Permitting/Production Services / Oil and Gas Division

SAD FORM

P.O. Box 12967

Austin, Texas 78711-2967

SECURITY ADMINISTRATOR DESIGNATION

FOR ELECTRONIC FILING

SEE INSTRUCTIONS ON BACK

I. COMPANY IDENTIFICATION

HECK

PPROPRIATE

[ ] Operator

[ ] Petroleum Consultant/Independent Contractor or other Non-Operator

OMPLETE THE

OLLOWING

Company Name: ___________________________________ RRC P-5 Number, if Operator: _________

Mailing Address: ______________________________________________________________________

Phone No.: _____________ Fax No.: _________________ E-mail Address: _______________________

II. SECURITY ADMINISTRATOR IDENTIFICATION

OU MUST

OMPLETE THE

OLLOWING TO

ARTICIPATE AS A

ECURITY

DMINISTRATOR

Name of Security Administrator: _________________________________________________________

Mailing Address if Different from Above: __________________________________________________

E-mail Address: ______________________________________________________________________

Phone No.: ___________________________________________________________________________

Fax No.: _____________________________________________________________________________

Initial One-Time Use Password: ________________________________

CERTIFICATION

I declare, under penalties prescribed in Sec. 91.143, Texas Natural Resources Code, that I am authorized to

make this Security Administrator Designation, that it was prepared by me or under my supervision and direction, and

that the information stated herein is true, correct, and complete, to the best of my knowledge and belief.

I further declare that all electronic filings made pursuant to this designation will be in the manner prescribed

by the Railroad Commission of Texas and will be compatible with the software, equipment, and facilities required

by the Railroad Commission of Texas. All electronic filings will comply with any required procedures for

participation in electronic filing.

I further declare that any filings which I make on behalf of another party will be made only if I have been

authorized by that party to file on its behalf and I acknowledge that any filings made on behalf of an operator by me

as an independent third party which are subsequently determined by the Commission to be made without the

operator's authorization may result in the suspension or revocation of this Security Administrator Designation and/or

the right to make any filings at the Commission on behalf of other

parties.

For RRC Use Only

SIGNATURE: ______________________________________

Approval Date: ____________

Initials: __________________

NAME (Print): ______________________________________

TITLE: ____________________________________________

Security Administrator Designation For Electronic Filing Form - Railroad Commission Of Texas

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