Oil & Gas Project Description

Lease Number

Please, follow this Form's Instructions to ensure that an Acknowledgment Form for this lease is on file as required pursuant 19.2.24.8 (B) NMAC, before proceeding with the Project Description Form. Complete and sign the Acknowledgment Form found on this web portal, if there is not one for this lease.

Proponent Name (Party conducting the project)

Lessee Operator Grantee Legal Representative

Phone

Project Name

Describe briefly the ground disturbing activity or set of activities within the project area (ie. well drilling, overhead electric, SWD/oil/gas pipelines, or various facilities). Make sure to include all activities within the project area. Mention which activities are buried or surface.

Total acreage the proposed set of activities will occupy

Does your project involve federal or other state agencies? Yes No

The proposed project is located on New Mexico State Trust Lands in:

Project Location (Township, Range, Section)

Submission of Required Documents

The NMSLO Cultural Resources Cover Sheet provided to you by a permitted archaeologist, indicates that an ARMS Inspection or an Archaeological Survey (whichever was chosen in the form) has been conducted for this proposed project. ARMS Inspection has been conducted Archaeological Survey has been conducted

Please, upload the following documents to support the review of your project. If possible, submit the NMSLO Cultural Resources Cover Sheet, the project location maps and the cadastral maps (#1 to #3) as one pdf document:

NMSLO Cultural Resources Cover Sheet
Project Location Maps
Cadastral Plats
Digital location files for the proposed project in ArcGIS shapefile, or kmz/kml format

Digital Files Custodian Name if different from Proponent

Phone

Upload Docs (Cover Sheet, Maps, Plats, Images)

Comments

Cultural Properties Protection

By signing below, the Party conducting this project affirms that there is a signed Cultural Properties Protection Acknowledgment Form for this lease, that they have read the Notice and the Instructions for Compliance, and that they have reviewed and agree to comply with all applicable laws related to the protection of cultural properties on state land including the NMSLO’s Cultural Properties Protection Rule (19.2.24 NMAC). If a Party is other than a natural person, the individual signing below attests that they have the authority to execute this project on behalf of and bind that Party.

Signature

Yes, I have read and will comply

[Signature box]

Certified on 04/18/2022

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