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File Number: (For OSE Use Only) NEW MEXICO OFFICE OF THE STATE ENGINEER APPLICATION FOR PERMIT TO CHANGE LOCATION OF WELL 1. WATER RIGHT OWNER Name: 7nrrn Ranch Contact: Brice Gordon Address: 49 Zorro Ranch City: Stanley 2. PURPOSE OF USE Work Phone: Home Phone: State: NM Zip: 87056 Domestic: X Livestock: X Irrigation: X Municipal: Industrial: Commercial: Other (specify): Ranch Related Specific use: 3. QUANTITY Consumptive Use: acre-feet per annum Diversion Amount: 68 acre-feet per annum 4. PLACE OF USE 24 acres of land described as follows: Subdivision of Section Section Township Range Acres (District or (Map No.) (Tract No.) Hydrographic Survey) SW 1/4 SW 1/4 NE 114 1211_ QE SF 114 22_ 1.2N_ 20_ Who is the owner of the land? Jeffrey Fpctein Trustee Do Not Write Below This Line File Number: Trn Number: Form: wr-06 page 1 of 4 EFTA01222825 File Number: (For OSE Use Only) NEW MEXICO OFFICE OF THE STATE ENGINEER APPLICATION FOR PERMIT TO CHANGE LOCATION OF WELL 5. CHANGE FROM A. LOCATION OF WELL (Location a, b, c, d required, e or f if known) AN 1/4 AN 1/4 a. N N S/E 1/4 Section:23 12 Township: Range:9 N.M.P.M. in Santa Fe County. b. X feet, Y feet, N.M. Coordinate System Zone in the Grant. U.S.G.S. Quad Map c. Latitude: d m s Longitude: d. East (m), North (m), UTM Zone 13, NAD (27 or 83) e. Tract No. , Map No. of the Hydrographic Survey f. Lot No. , Block No. of Unit/Tract of the Subdivision recorded in County. Other: g• h. Give State Engineer File Number of existing well: i. On land owned by (required) : Jeffrey Epstein, Trustee i• E-7871S Is well to be plugged or capped? If not, state for what use retained: Not Drilled Do Not Write Below This Line File Number: Trn Number: Form: wr-06 page 2 of 4 EFTA01222826 File Number: (For OSE Use Only) NEW MEXICO OFFICE OF THE STATE ENGINEER APPLICATION FOR PERMIT TO CHANGE LOCATION OF WELL 6. CHANGE TO A. LOCATION OF WELL (Location a, b, c, d required, e or f if known) a. NF 1/4 SF 1/4 SF 1/4 Section:97 Township:12 Range:9 N.M.P.M. in County. b. X feet, Y feet, N.M. Coordinate System Zone in the Grant. U.S.G.S. Quad Map c. Latitude: s Longitude: 1AS d SA m 99 d. East (m), North (m), UTM Zone 13, NAD (27 or 83) e. Tract No. , Map No. of the Hydrographic Survey f. Lot No. , Block No. of Unit/Tract of the Subdivision recorded in County. Other: g• h. Give State Engineer File Number of existing well: E 7871S i. On land owned by (required): j• If new well, give approximate depth(if known)410.2500feet; Outside diameter of casing A inches. Name of driller and license number (if known) NO1C0n1rAdOd 7. REASON FOR CHANGE Application is made to change location of well for the following reasons: To move existing well location closer to supporting infrastructure 8. ADDITIONAL STATEMENTS OR EXPLANATIONS: Our intend to drill to the Cretaceous bedrock Aquifer Do Not Write Below This Line File Number: Trn Number: Form: wr-06 page 3 of 4 EFTA01222827 File Number: (For OSE Use Only) NEW MEXICO OFFICE OF THE STATE ENGINEER APPLICATION FOR PERMIT TO CHANGE LOCATION OF WELL ACKNOWLEDGEMENT (I, we) Brice Gordon affirm that the (Please Print) foregoing statements are true to the best of (my, our) knowledge and belief. Applicant Signature Applicant Signature ACTION OF STATE ENGINEER This application is approved/denied/partially approved provided it is not exercised to the detriment of any others having existing rights, and is not contrary to the conservation of water in New Mexico nor detrimental to the public welfare; and further subject to the following conditions: Witness my hand and seal this day of 20 State Engineer By: Do Not Write Below This Line File Number: Trn Number: Form: wr-06 page 4 of 4 EFTA01222828