Form 3200-9 Notice of Intent to Conduct Geothermal Resource Explorat

Form 3200-9
(February 2005)

UNITED STATES
DEPARTMENT OF THE INTERIOR

FORM APPROVED
OMB No. 1004-0074
Expires: September 30, 2006

BUREAU OF LAND MANAGEMENT

NOTICE OF INTENT TO CONDUCT GEOTHERMAL RESOURCE
EXPLORATION OPERATIONS
Applicant(s)

Address (include zip code)

Operator (name and telephone number) include area code

Address (include zip code)

Contractor(s)

Address (include zip code)

hereby apply for authorization to conduct exploration operations pursuant to the provisions of 43 CFR 3250 now or hereafter in force across and upon
the following-described lands (give description of lands by township, attach map or maps showing lands to be entered or affected).

Type of operations to be conducted (give brief description).
Exploration operations will be conducted during the period (date) from
Attached

$

Surety bond

to

Rider to Nationwide bond

Rider to Statewide bond

Bond to be furnished

Upon completion of exploration operations, the undersigned agrees to notify the Bureau of Land Management (BLM) that authorized exploration
operations have been completed in conformance with the general and special terms and stipulations of the notice.
The undersigned hereby agrees (1) that he will not enter upon the described land until he has been informed in writing whether there are special
stipulations applicable to his Notice of Intent, as to either time or method of operation or otherwise, and if there are such stipulations, what those
stipulations are, (2) that he will comply with those special stipulations, if any; and (3) that he will not enter upon the described lands until his entry
has been approved by the BLM.
The undersigned agrees to be bound by the terms and conditions of this notice to conduct exploration operations when approved by the BLM.
The undersigned agrees that the filing of this Notice under the
regulations (43 CFR Subpart 3250) does not vest or confer any
preference right to a geothermal resources lease.
The undersigned agrees further that all exploration operations must
be conducted pursuant to the following terms and conditions:

1. Exploration operations must be conducted in compliance with all
Federal, State, and local laws, ordinances, or regulations which
are applicable to the area of operations including, but not limited
to, those pertaining to fire, sanitation, conservation, water
pollution, fish, and game. All operations hereunder must be
conducted in a prudent manner.
2. Due care must be exercised in protecting the described lands
from damage. All necessary precautions must be taken to avoid
any damage other than normal wear and tear to improvements on
the land including, but not limited to, gates, bridges, roads,
culverts, cattle guards, fences, dams, dikes, vegetative cover,
improvements, stock watering, and other facilities.
3. All drill holes must be capped when not in use and appropriate
procedures must be taken to protect against hazards in order to
protect the lives, safety, or property of other persons or of
wildlife and livestock.

(Continued on page 2)

4. All vehicles must be operated at a reasonable rate of speed and, in the
operation of vehicles, due care must be taken to safeguard livestock
and wildlife in the vicinity of operations. Existing roads and trails
must be used wherever possible. If new roads and trails are to be
constructed, the BLM must be consulted prior to construction
as to location and specifications. Reclamation and/or seeding of
new roads and trails must be made as requested by the BLM.
5. Upon expiration, conclusion, or abandonment of operations conducted
pursuant to this Notice, all equipment must be removed from the land,
and the land must be restored as nearly as practicable to its original
condition by such measures as the BLM may specify.
All geophysical holes shall be safely plugged. The BLM must be
furnished a Notice of Completion of Geothermal Resource
Exploration Operations (Form 3200-10) immediately upon cessation
of all such operations and must be further informed of the completion
of reclamation work as soon as possible.
6. Location and depth of water sands encountered must be disclosed to
the BLM.

7.

Operator must contact the BLM prior to actual entry upon the land
in order to be appraised of practices which must be followed or
avoided in the conduct of exploration operations pursuant to
the terms of this Notice and applicable regulations.
Operator will conduct no operations on the land unless the attached
bond is in good standing.

8. Due care must be exercised to avoid scarring or removal of ground
vegetative cover.
9. All operations must be conducted in such a manner to avoid (a)
blockage of any drainage systems; (b) changing the character, or
causing the pollution or siltation of rivers, streams, lakes, ponds,
waterholes, seeps and marshes; and (c) damaging fish and wildlife
resources or habitat. Cuts or fills causing any of the abovementioned problems will be repaired immediately in accordance with
specification of the BLM.
10. Vegetation must not be disturbed within 300 feet of waters
designated by the BLM, except at approved stream crossings.
11. Surface damage which induces soil movement and/or water pollution
must be subject to corrective action as required by the BLM.
12. Trails and campsites must be kept clean. All garbage and foreign
debris must be eliminated as required by the BLM.
13. Operator must protect all survey monuments, witness corners,
reference monuments, and bearing trees against destruction,
obliteration, or damage. He must, at his expense, reestablish
damaged, destroyed, or obliterated monuments and corners, using a
licensed surveyor, in accordance with Federal survey procedures. A
record of the reestablishment must be submitted to the BLM.

14. Operator must make every reasonable effort to prevent, control, or
suppress any fires started by the operator, and to report, as soon as
possible, to the BLM location and size of fires, and assistance
needed to suppress such fires. Operator must inform the BLM
as soon as possible of all fires, regardless of location, noted, or
suppressed by independent action.
15. No work must be done within one-half mile of a developed recreation
site without specific written authority from the BLM. Any tavel
within one-half mile of a recreation site must be over existing
roads or trails.
16. Use of explosives within one-half mile of designated waters is
prohibited unless approved, in writing, by the BLM.
17. If operations conducted under the provisions of this Notice causes
any damage to the surface of the national resource lands, such as, but
not limited to, soil erosion, pollution of water, injury or destruction
of livestock or wildlife, or littering, operator must, within 48 hours,
file with the BLM a map showing exact location of such damage
and a written report containing operator's plans for correcting or
minimizing damage, if possible.
18. Violation of, or failure to comply with any of these terms and
conditions will result in immediate shutdown of field operations
until deficiency is corrected. Failure to correct deficiency within the
time period allowed by the BLM will result in forfeiture of
bond.
19. The Bureau of Land Management reserves the right to close any area
to operators in periods of fire danger or when irreparable damage to
natural resources is imminent.
20. Contractor will be liable for assuring compliance with all terms and
conditions of this Notice and all sections of his designated operator,
agents, and employees.
21. Where continuation of the operation will result in irreparable damage
to the land and other natural resources this Notice will be
immediately canceled by the BLM.

22. Special Stipulations:

(Signature of Applicant)

(Date)

(Signature of Operator)

(Date)

We hereby agree to the special stipulations added and made a part of this Notice to conduct exploration operations.

(Signature of Holder of Notice)

(Date)

(Signature of Operator)

(Date)

I hereby approve this Notice to conduct exploration operations.

(Signature of BLM)

(Title)

Title 18 U.S.C. Section 1001, makes it a crime for any person knowingly and willfully to make to any department or agency of the United States any false, fictitious,
or fraudulent statements or representations as to any matter within its jurisdiction.
(Continued on page 3)

(Form 3200-9, page 2)

NOTICES
The Privacy Act of 1974 and the regulation in 43 CFR 2.48(d) provide that you be furnished the
following information in connection with information required by this Notice of intent to Conduct
Geothermal Resource Exploration Operations.
AUTHORITY: 30 U.S.C. 1001-1025.
PRINCIPAL PURPOSE: The information is to be used to process your request for authorization to
conduct exploration operations.
ROUTINE USES: (1) The adjudication of the request for authorization to conduct exploration operations.
(2) Documentation for public information. (3) Transfer to appropriate Federal agencies when concurrence
is required prior to granting a right in National Resource lands or resources. (4)(5) Information from the
record and/or the record will be transferred to appropriate Federal, State, local or foreign agencies, when
relevant to civil, criminal or regulatory investigations or prosecutions.
EFFECT OF NOT PROVIDING INFORMATION: Disclosure of the information is voluntary. If all the
information is not provided, your request for authorization may be denied.
The Paperwork Reduction Act of 1995 requires us to inform you that:
BLM collects this information in accordance with 43 CFR 3250.
This information will be used to identify and communicate with the parties involved.
Response to this request is required to obtain a benefit.
BLM would like you to know that you do not have to respond to this or any other Federal agencysponsored information collection unless it displays a currently valid OMB control number.
BURDEN HOURS STATEMENT: Public reporting burden for this form is estimated to average 2
hours per response including the time for reviewing instructions, gathering and maintaining data, and
completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of
this form to U.S. Department of the Interior, Bureau of Land Management (1004-0074), Bureau
Information Collection Clearance Officer (WO-630), 1849 C Street, N.W., Mail Stop 401 LS,
Washington, D.C. 20240.

____________________________________________________________________________________________________________________________________________________________________________
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(Form 3200-9, page 3)