Alaska Department of Environmental Conservation

Alaska Department of Environmental Conservation

Division of Air Quality - Air Permit Program

Air Quality Control General Permit

AMENDMENT 2

TO

MG1 NOTIFICATION OF INTENT TO OPERATE

MINOR GENERAL PERMIT MG1

OIL & GAS DRILLING RIGS

This form is for Portable Oil and Gas Operations south of 69 degrees 30 minutes North latitude.

Use this form to amend an original notification to allow drilling more wells in a fiscal year than the number identified in the original notification.

This amendment only affects drilling sites identified in the original notification.

Company Name

Name of Prospect (s)

Date of Initial Notification this amendment applies to

Name of Drilling Rig

Dates this amendment applies to
(Dates must be in a single fiscal year. Those dates must be included under your original MG1 Notification of Intent to Operate for this project.)
Beginning Ending
Number of wells
authorized under the
Original Notification
(check one) / Associated Payment / Total number of wells authorized for the fiscal year under this amendment
(check one) / Associated Payment
Column 1
1 - 5 $1685
6 - 10 $3370 / Column 2
6 - 10 $3370
11 or more $5055
With this form, submit payment for the difference between the dollar amounts you checked in columns 1 and 2.

CERTIFICATION PAGE

FOR

MINOR PERMITS

18 AAC 50.205 Certification. Any permit application, report, or compliance certification required by the department under a permit program established under AS 46.14 must include the signature of a responsible official for the permitted stationary source.

Based on information and belief formed after reasonable inquiry, I certify that the statements and information in and attached to this document are true, accurate and complete.

______

Signature

______

Printed Name

______

Title

Amendment 2 to MG1 Notification Of Intent To Operate Page 1 of 3

Issued December 15, 2005