Code of Colorado Regulations
400 - Department of Natural Resources
404 - Oil and Gas Conservation Commission
2 CCR 404-1 - PRACTICE AND PROCEDURE
Appendix 2 CCR 404-1-IX - FORM 41

Form 41 Section A - Classification of Entity Asserting Trade Secret Claim

__ Operator __ Vendor __ Service provider ___ Other - specify in detail: _____________

Section B - Entity Asserting Trade Secret Claim

The entity below submits this form to claim that it is entitled under COGCC Rule 205A to withhold certain information from disclosure as a trade secret:

Entity name: _________________________________

Street Address: _________________________________

City/State/Zip Code: ___________________________________

Contact person: ________________________

Contact phone: ___________________ Contact fax: ______________________

Contact email: ______________________________________

Section C - Claim of Entitlement to Trade Secret Protection

Rule 205A requires disclosure of all chemicals intentionally added to base fluid as part of a hydraulic fracturing treatment, as well as the maximum concentrations and (if applicable) CAS numbers for those chemicals, except in those limited situations where the specific identity or concentration of a chemical are permitted to be withheld as a trade secret. For purposes of Rule 205A, the term "trade secret" is defined in the COGCC Series 100 Definitions.

The Entity identified in Section B claims that the (____) identity or (___) maximum concentration, or (__) both, of the following chemical qualifies as a trade secret:

__________________________ (Chemical identifier). You may use a descriptive label, such as

"Company TS1," for a chemical identifier in lieu of identifying the chemical. This chemical identifier may be used to reference the chemical in subsequent disclosures filed with the Chemical Disclosure Registry.

In order to claim that information is entitled to protection as a trade secret, you must check all the affirmations below and submit specific information regarding each of the following (can be attached on separate pages).

__ 1. The entity holding the trade secret information has not disclosed the information to any other person, other than a member of a local emergency planning committee, an officer or employee of the United States or a state or local government, an employee of such person, or a person who is bound by a confidentiality agreement, and such person has taken reasonable measures to protect the confidentiality of such information and intends to continue to take such measures, or disclosure has otherwise been limited such that the information is not readily available to competitors.

__ 2. The information is not required to be disclosed, or otherwise made available, to the public under any other Federal or State law.

__ 3. Disclosure of the information is likely to cause harm to the competitive position of the entity holding the trade secret information.

__ 4. The information is not readily discoverable through reverse engineering.

CERTIFICATION

This form must be signed by an authorized agent of the entity identified in Section B.

I declare under penalty of perjury that this report has been examined by me and to the best of my knowledge is true, correct and complete.

____________________________________

Signature

____________________________________

Name and title