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HomeMy WebLinkAboutNorth Cook Inlet - Hilcorp Alaska, LLCSTATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT NET OIL SALES Hilcorp Alaska, LLC North Cook Inlet JANUARY 2021 Name of Operator Regulatory Lease Month and Year of Production Total Wells 17 Total Wells Produced 8 Total Pipeline Runs 0 Closing Inventory 0 Opening Inventory 0 Other Adjustments 0 (direct or xylene recovered) Total Net Production 0 I hereby certify that the foregoing is true and correct to the best of my knowledge. Signed 0 9,514 507,449 Beth Farouse TOTAL OIL WATER GAS Title Production Analyst Date:2/17/2021 STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Sterling, Undefined Gas Month and Year: JANUARY 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-03 50-883-20020-00-00 2 564550 1 25 210 0 0 965 0 0 24,120 24,12000 14. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name: Certified Signature: Beth Farouse Title:Production Analyst Contact Phone:713-289-2627 Contact Email:bfarouse@hilcorp.com Revision? Date: Form 10-405 Rev. 04/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Tertiary gas Month and Year: JANUARY 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-01 50-883-20016-00-00 2 564570 8 0 80 0 0 0 0 0 0 A-02 50-883-20018-00-00 2 564570 1 31 109 0 7 3,449 0 232 106,929 A-03 50-883-20020-00-00 2 564570 8 0 210 0 0 0 0 0 0 A-04 50-883-20023-00-00 2 564570 8 0 10 0 0 0 0 0 0 A-05 50-883-20025-00-00 2 564570 1 31 108 0 0 5,920 0 0 183,522 A-06 50-883-20026-00-00 2 564570 8 0 60 0 0 0 0 0 0 A-07 50-883-20027-00-00 2 564570 1 31 222 0 0 1,010 0 0 31,304 A-08 50-883-20028-00-00 2 564570 8 0 170 0 0 0 0 0 0 A-09 50-883-20029-00-00 2 564570 8 0 658 0 0 0 0 0 0 A-10A 50-883-20030-01-00 2 564570 8 0 250 0 0 0 0 0 0 A-12 L 50-883-20032-00-00 2 564570 8 0 22 0 0 0 0 0 0 B-01A L 50-883-20093-01-00 2 564570 8 0 402 0 0 0 0 0 0 B-03 50-883-20095-00-00 2 564570 2 31 57 0 159 1,058 0 4,917 32,784 A-14 50-883-20125-00-00 2 564570 2 31 52 0 64 370 0 1,994 11,467 A-15 50-883-20126-00-00 2 564570 2 31 53 0 52 1,427 0 1,608 44,246 A-16 50-883-20127-00-00 2 564570 2 31 57 0 25 2,357 0 763 73,076 483,3289,5140 14. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name: Certified Signature: Beth Farouse Title:Production Analyst Contact Phone:713-289-2627 Contact Email:bfarouse@hilcorp.com Revision? Date: Form 10-405 Rev. 04/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY INJECTION REPORT 20 AAC 25.432 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Undefined WDSP Month and Year: JANUARY 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.9. MAX PSIG 10. AVG PSIG 11. LIQUID (BBL) 12. GAS (MCF) 13. LIQUID (BBL) 14. GAS (MCF) CASING PRESS.TUBING PRESS. 7. MAX PSIG 8. AVG PSIG DAILY AVG. INJ.TOTAL MONTHLY INJ. A-12 S 50-883-20032-00-00 5 564036 8 0 23 22 32 29 0 0 0 0 A-13 50-883-20087-00-00 5 564036 9 9 1,502 388 243 114 444 0 3,994 0 B-01A S 50-883-20093-01-00 5 564036 8 0 403 402 403 401 0 0 0 0 03,994 15. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name:Beth Farouse Title:Production Analyst Certified Signature:Contact Email:bfarouse@hilcorp.com Contact Phone:713-289-2627 Revision? Date: Form 10-406 Rev. 02/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT NET OIL SALES Hilcorp Alaska, LLC North Cook Inlet FEBRUARY 2021 Name of Operator Regulatory Lease Month and Year of Production Total Wells 17 Total Wells Produced 7 Total Pipeline Runs 0 Closing Inventory 0 Opening Inventory 0 Other Adjustments 0 (direct or xylene recovered) Total Net Production 0 I hereby certify that the foregoing is true and correct to the best of my knowledge. Signed 0 11,377 418,028 Beth Farouse TOTAL OIL WATER GAS Title Production Analyst Date:3/15/2021 STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Sterling, Undefined Gas Month and Year: FEBRUARY 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-03 50-883-20020-00-00 2 564550 8 0 145 0 0 0 0 0 0 000 14. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name: Certified Signature: Beth Farouse Title:Production Analyst Contact Phone:713-289-2627 Contact Email:bfarouse@hilcorp.com Revision? Date: Form 10-405 Rev. 04/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Tertiary gas Month and Year: FEBRUARY 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-01 50-883-20016-00-00 2 564570 8 0 81 0 0 0 0 0 0 A-02 50-883-20018-00-00 2 564570 1 28 110 0 7 3,114 0 200 87,191 A-03 50-883-20020-00-00 2 564570 8 0 145 0 0 0 0 0 0 A-04 50-883-20023-00-00 2 564570 8 0 10 0 0 0 0 0 0 A-05 50-883-20025-00-00 2 564570 1 28 101 0 0 5,671 0 0 158,788 A-06 50-883-20026-00-00 2 564570 8 0 56 0 0 0 0 0 0 A-07 50-883-20027-00-00 2 564570 1 19 495 0 146 1,066 0 2,767 20,255 A-08 50-883-20028-00-00 2 564570 8 0 178 0 0 0 0 0 0 A-09 50-883-20029-00-00 2 564570 8 0 650 0 0 0 0 0 0 A-10A 50-883-20030-01-00 2 564570 8 0 242 0 0 0 0 0 0 A-12 L 50-883-20032-00-00 2 564570 8 0 21 0 0 0 0 0 0 B-01A L 50-883-20093-01-00 2 564570 8 0 403 0 0 0 0 0 0 B-03 50-883-20095-00-00 2 564570 2 24 124 0 167 393 0 4,020 9,432 A-14 50-883-20125-00-00 2 564570 2 28 53 0 75 1,074 0 2,096 30,069 A-15 50-883-20126-00-00 2 564570 2 28 53 0 53 1,334 0 1,479 37,345 A-16 50-883-20127-00-00 2 564570 2 28 59 0 29 2,677 0 816 74,949 418,02811,3770 14. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name: Certified Signature: Beth Farouse Title:Production Analyst Contact Phone:713-289-2627 Contact Email:bfarouse@hilcorp.com Revision? Date: Form 10-405 Rev. 04/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY INJECTION REPORT 20 AAC 25.432 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Undefined WDSP Month and Year: FEBRUARY 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.9. MAX PSIG 10. AVG PSIG 11. LIQUID (BBL) 12. GAS (MCF) 13. LIQUID (BBL) 14. GAS (MCF) CASING PRESS.TUBING PRESS. 7. MAX PSIG 8. AVG PSIG DAILY AVG. INJ.TOTAL MONTHLY INJ. A-12 S 50-883-20032-00-00 5 564036 8 0 23 21 29 27 0 0 0 0 A-13 50-883-20087-00-00 5 564036 9 7 1,505 371 230 108 520 0 3,637 0 B-01A S 50-883-20093-01-00 5 564036 8 0 404 403 404 403 0 0 0 0 03,637 15. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name:Beth Farouse Title:Production Analyst Certified Signature:Contact Email:bfarouse@hilcorp.com Contact Phone:713-289-2627 Revision? Date: Form 10-406 Rev. 02/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT NET OIL SALES Hilcorp Alaska, LLC North Cook Inlet MARCH 2021 Name of Operator Regulatory Lease Month and Year of Production Total Wells 17 Total Wells Produced 7 Total Pipeline Runs 0 Closing Inventory 0 Opening Inventory 0 Other Adjustments 0 (direct or xylene recovered) Total Net Production 0 I hereby certify that the foregoing is true and correct to the best of my knowledge. Signed 0 7,555 463,422 Beth Farouse TOTAL OIL WATER GAS Title Production Analyst Date:4/15/2021 STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Sterling, Undefined Gas Month and Year: MARCH 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-03 50-883-20020-00-00 2 564550 8 0 125 0 0 0 0 0 0 000 14. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name: Certified Signature: Beth Farouse Title:Production Analyst Contact Phone:713-289-2627 Contact Email:bfarouse@hilcorp.com Revision? Date: Form 10-405 Rev. 04/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Tertiary gas Month and Year: MARCH 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-01 50-883-20016-00-00 2 564570 8 0 80 0 0 0 0 0 0 A-02 50-883-20018-00-00 2 564570 1 31 108 0 4 3,276 0 132 101,558 A-03 50-883-20020-00-00 2 564570 8 0 125 0 0 0 0 0 0 A-04 50-883-20023-00-00 2 564570 8 0 11 0 0 0 0 0 0 A-05 50-883-20025-00-00 2 564570 1 31 102 0 0 5,966 0 0 184,939 A-06 50-883-20026-00-00 2 564570 8 0 67 0 0 0 0 0 0 A-07 50-883-20027-00-00 2 564570 1 25 288 0 95 1,203 0 2,364 30,079 A-08 50-883-20028-00-00 2 564570 8 0 180 0 0 0 0 0 0 A-09 50-883-20029-00-00 2 564570 8 0 646 0 0 0 0 0 0 A-10A 50-883-20030-01-00 2 564570 8 0 250 0 0 0 0 0 0 A-12 L 50-883-20032-00-00 2 564570 8 0 22 0 0 0 0 0 0 B-01A L 50-883-20093-01-00 2 564570 8 0 401 0 0 0 0 0 0 B-03 50-883-20095-00-00 2 564570 2 31 58 0 110 65 0 3,411 2,022 A-14 50-883-20125-00-00 2 564570 2 31 54 0 38 448 0 1,174 13,896 A-15 50-883-20126-00-00 2 564570 2 31 55 0 6 1,262 0 195 39,126 A-16 50-883-20127-00-00 2 564570 2 31 60 0 9 2,961 0 279 91,802 463,4227,5550 14. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name: Certified Signature: Beth Farouse Title:Production Analyst Contact Phone:713-289-2627 Contact Email:bfarouse@hilcorp.com Revision? Date: Form 10-405 Rev. 04/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY INJECTION REPORT 20 AAC 25.432 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Undefined WDSP Month and Year: MARCH 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.9. MAX PSIG 10. AVG PSIG 11. LIQUID (BBL) 12. GAS (MCF) 13. LIQUID (BBL) 14. GAS (MCF) CASING PRESS.TUBING PRESS. 7. MAX PSIG 8. AVG PSIG DAILY AVG. INJ.TOTAL MONTHLY INJ. A-12 S 50-883-20032-00-00 5 564036 8 0 23 22 33 30 0 0 0 0 A-13 50-883-20087-00-00 5 564036 9 9 1,488 525 273 135 484 0 4,360 0 B-01A S 50-883-20093-01-00 5 564036 9 1 410 401 409 406 301 0 301 0 04,660 15. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name:Beth Farouse Title:Production Analyst Certified Signature:Contact Email:bfarouse@hilcorp.com Contact Phone:713-289-2627 Revision? Date: Form 10-406 Rev. 02/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT NET OIL SALES Hilcorp Alaska, LLC North Cook Inlet APRIL 2021 Name of Operator Regulatory Lease Month and Year of Production Total Wells 17 Total Wells Produced 6 Total Pipeline Runs 0 Closing Inventory 0 Opening Inventory 0 Other Adjustments 0 (direct or xylene recovered) Total Net Production 0 I hereby certify that the foregoing is true and correct to the best of my knowledge. Signed 0 3,237 417,986 Beth Farouse TOTAL OIL WATER GAS Title Production Analyst Date:5/17/2021 STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Sterling, Undefined Gas Month and Year: APRIL 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-03 50-883-20020-00-00 2 564550 8 0 136 0 0 0 0 0 0 000 14. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name: Certified Signature: Beth Farouse Title:Production Analyst Contact Phone:713-289-2627 Contact Email:bfarouse@hilcorp.com Revision? Date: Form 10-405 Rev. 04/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Tertiary gas Month and Year: APRIL 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-01 50-883-20016-00-00 2 564570 8 0 85 0 0 0 0 0 0 A-02 50-883-20018-00-00 2 564570 1 28 113 0 26 3,534 0 722 98,954 A-03 50-883-20020-00-00 2 564570 8 0 136 0 0 0 0 0 0 A-04 50-883-20023-00-00 2 564570 8 0 10 0 0 0 0 0 0 A-05 50-883-20025-00-00 2 564570 1 30 110 0 1 5,779 0 45 173,368 A-06 50-883-20026-00-00 2 564570 8 0 76 0 0 0 0 0 0 A-07 50-883-20027-00-00 2 564570 8 0 226 0 0 0 0 0 0 A-08 50-883-20028-00-00 2 564570 8 0 181 0 0 0 0 0 0 A-09 50-883-20029-00-00 2 564570 8 0 636 0 0 0 0 0 0 A-10A 50-883-20030-01-00 2 564570 8 0 246 0 0 0 0 0 0 A-12 L 50-883-20032-00-00 2 564570 8 0 15 0 0 0 0 0 0 B-01A L 50-883-20093-01-00 2 564570 8 0 169 0 0 0 0 0 0 B-03 50-883-20095-00-00 2 564570 2 29 96 0 27 156 0 776 4,530 A-14 50-883-20125-00-00 2 564570 2 30 58 0 10 432 0 298 12,956 A-15 50-883-20126-00-00 2 564570 2 30 59 0 24 1,345 0 709 40,338 A-16 50-883-20127-00-00 2 564570 2 30 63 0 23 2,928 0 688 87,840 417,9863,2370 14. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name: Certified Signature: Beth Farouse Title:Production Analyst Contact Phone:713-289-2627 Contact Email:bfarouse@hilcorp.com Revision? Date: Form 10-405 Rev. 04/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY INJECTION REPORT 20 AAC 25.432 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Undefined WDSP Month and Year: APRIL 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.9. MAX PSIG 10. AVG PSIG 11. LIQUID (BBL) 12. GAS (MCF) 13. LIQUID (BBL) 14. GAS (MCF) CASING PRESS.TUBING PRESS. 7. MAX PSIG 8. AVG PSIG DAILY AVG. INJ.TOTAL MONTHLY INJ. A-12 S 50-883-20032-00-00 5 564036 8 0 24 15 39 32 0 0 0 0 A-13 50-883-20087-00-00 5 564036 9 9 1,474 406 303 117 427 0 3,843 0 B-01A S 50-883-20093-01-00 5 564036 8 0 409 169 409 144 0 0 0 0 03,843 15. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name:Beth Farouse Title:Production Analyst Certified Signature:Contact Email:bfarouse@hilcorp.com Contact Phone:713-289-2627 Revision? Date: Form 10-406 Rev. 02/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT NET OIL SALES Hilcorp Alaska, LLC North Cook Inlet MAY 2021 Name of Operator Regulatory Lease Month and Year of Production Total Wells 18 Total Wells Produced 8 Total Pipeline Runs 0 Closing Inventory 0 Opening Inventory 0 Other Adjustments 0 (direct or xylene recovered) Total Net Production 0 I hereby certify that the foregoing is true and correct to the best of my knowledge. Signed 0 8,852 467,663 Beth Farouse TOTAL OIL WATER GAS Title Production Analyst Date:6/14/2021 STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Sterling, Undefined Gas Month and Year: MAY 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-03 50-883-20020-00-00 2 564550 8 0 79 0 0 0 0 0 0 000 14. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name: Certified Signature: Beth Farouse Title:Production Analyst Contact Phone:713-289-2627 Contact Email:bfarouse@hilcorp.com Revision? Date: Form 10-405 Rev. 04/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Tertiary gas Month and Year: MAY 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-01 50-883-20016-00-00 2 564570 8 0 88 0 0 0 0 0 0 A-02 50-883-20018-00-00 2 564570 1 31 106 0 38 3,469 0 1,184 107,531 A-03 50-883-20020-00-00 2 564570 8 0 79 0 0 0 0 0 0 A-04 50-883-20023-00-00 2 564570 8 0 27 0 0 0 0 0 0 A-05 50-883-20025-00-00 2 564570 1 31 103 0 2 6,030 0 66 186,941 A-06 50-883-20026-00-00 2 564570 8 0 104 0 0 0 0 0 0 A-07 50-883-20027-00-00 2 564570 2 3 272 0 12 278 0 37 835 A-08 50-883-20028-00-00 2 564570 8 0 186 0 0 0 0 0 0 A-09 50-883-20029-00-00 2 564570 8 0 638 0 0 0 0 0 0 A-10A 50-883-20030-01-00 2 564570 8 0 251 0 0 0 0 0 0 A-12 L 50-883-20032-00-00 2 564570 8 0 5 0 0 0 0 0 0 B-02 50-883-20090-01-00 2 564570 2 31 10 0 1 0 0 45 0 B-01A L 50-883-20093-01-00 2 564570 8 0 416 0 0 0 0 0 0 B-03 50-883-20095-00-00 2 564570 2 31 63 0 104 670 0 3,230 20,785 A-14 50-883-20125-00-00 2 564570 1 31 57 0 26 444 0 806 13,757 A-15 50-883-20126-00-00 2 564570 2 31 58 0 32 1,459 0 987 45,216 A-16 50-883-20127-00-00 2 564570 1 31 63 0 81 2,987 0 2,498 92,599 467,6638,8520 14. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name: Certified Signature: Beth Farouse Title:Production Analyst Contact Phone:713-289-2627 Contact Email:bfarouse@hilcorp.com Revision? Date: Form 10-405 Rev. 04/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY INJECTION REPORT 20 AAC 25.432 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Undefined WDSP Month and Year: MAY 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.9. MAX PSIG 10. AVG PSIG 11. LIQUID (BBL) 12. GAS (MCF) 13. LIQUID (BBL) 14. GAS (MCF) CASING PRESS.TUBING PRESS. 7. MAX PSIG 8. AVG PSIG DAILY AVG. INJ.TOTAL MONTHLY INJ. A-12 S 50-883-20032-00-00 5 564036 8 0 6 5 50 43 0 0 0 0 A-13 50-883-20087-00-00 5 564036 9 12 1,445 546 234 89 514 0 6,172 0 B-01A S 50-883-20093-01-00 5 564036 8 0 436 416 438 419 0 0 0 0 06,172 15. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name:Beth Farouse Title:Production Analyst Certified Signature:Contact Email:bfarouse@hilcorp.com Contact Phone:713-289-2627 Revision? Date: Form 10-406 Rev. 02/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT NET OIL SALES Hilcorp Alaska, LLC North Cook Inlet JUNE 2021 Name of Operator Regulatory Lease Month and Year of Production Total Wells 18 Total Wells Produced 8 Total Pipeline Runs 0 Closing Inventory 0 Opening Inventory 0 Other Adjustments 0 (direct or xylene recovered) Total Net Production 0 I hereby certify that the foregoing is true and correct to the best of my knowledge. Signed 0 6,309 444,849 Beth Farouse TOTAL OIL WATER GAS Title Prduction Analyst Date:7/15/2021 STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Sterling, Undefined Gas Month and Year: JUNE 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-03 50-883-20020-00-00 2 564550 8 0 8 0 0 0 0 0 0 000 14. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name: Certified Signature: Beth Farouse Title:Prduction Analyst Contact Phone:713-289-2627 Contact Email:bfarouse@hilcorp.com Revision? Date: Form 10-405 Rev. 04/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Tertiary gas Month and Year: JUNE 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-01 50-883-20016-00-00 2 564570 8 0 96 0 0 0 0 0 0 A-02 50-883-20018-00-00 2 564570 1 30 105 0 5 3,407 0 146 102,207 A-03 50-883-20020-00-00 2 564570 8 0 8 0 0 0 0 0 0 A-04 50-883-20023-00-00 2 564570 8 0 0 0 0 0 0 0 0 A-05 50-883-20025-00-00 2 564570 1 30 101 0 1 6,131 0 39 183,934 A-06 50-883-20026-00-00 2 564570 8 0 209 0 0 0 0 0 0 A-07 50-883-20027-00-00 2 564570 2 8 203 0 4 0 0 30 0 A-08 50-883-20028-00-00 2 564570 8 0 193 0 0 0 0 0 0 A-09 50-883-20029-00-00 2 564570 8 0 640 0 0 0 0 0 0 A-10A 50-883-20030-01-00 2 564570 8 0 126 0 0 0 0 0 0 A-12 L 50-883-20032-00-00 2 564570 8 0 3 0 0 0 0 0 0 B-02 50-883-20090-01-00 2 564570 2 12 157 0 20 296 0 235 3,550 B-01A L 50-883-20093-01-00 2 564570 8 0 432 0 0 0 0 0 0 B-03 50-883-20095-00-00 2 564570 2 30 64 0 100 688 0 3,007 20,633 A-14 50-883-20125-00-00 2 564570 1 30 58 0 61 289 0 1,825 8,680 A-15 50-883-20126-00-00 2 564570 2 30 59 0 23 1,487 0 697 44,619 A-16 50-883-20127-00-00 2 564570 1 30 63 0 11 2,708 0 329 81,226 444,8496,3090 14. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name: Certified Signature: Beth Farouse Title:Prduction Analyst Contact Phone:713-289-2627 Contact Email:bfarouse@hilcorp.com Revision? Date: Form 10-405 Rev. 04/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY INJECTION REPORT 20 AAC 25.432 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Undefined WDSP Month and Year: JUNE 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.9. MAX PSIG 10. AVG PSIG 11. LIQUID (BBL) 12. GAS (MCF) 13. LIQUID (BBL) 14. GAS (MCF) CASING PRESS.TUBING PRESS. 7. MAX PSIG 8. AVG PSIG DAILY AVG. INJ.TOTAL MONTHLY INJ. A-12 S 50-883-20032-00-00 5 564036 8 0 4 3 56 52 0 0 0 0 A-13 50-883-20087-00-00 5 564036 9 14 1,428 606 83 40 430 0 6,017 0 B-01A S 50-883-20093-01-00 5 564036 8 0 438 432 439 436 0 0 0 0 06,017 15. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name:Beth Farouse Title:Prduction Analyst Certified Signature:Contact Email:bfarouse@hilcorp.com Contact Phone:713-289-2627 Revision? Date: Form 10-406 Rev. 02/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT NET OIL SALES Hilcorp Alaska, LLC North Cook Inlet JULY 2021 Name of Operator Regulatory Lease Month and Year of Production Total Wells 18 Total Wells Produced 8 Total Pipeline Runs 0 Closing Inventory 0 Opening Inventory 0 Other Adjustments 0 (direct or xylene recovered) Total Net Production 0 I hereby certify that the foregoing is true and correct to the best of my knowledge. Signed 0 13,481 591,192 Beth Farouse TOTAL OIL WATER GAS Title Production Analyst Date:8/19/2021 STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Sterling, Undefined Gas Month and Year: JULY 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-03 50-883-20020-00-00 2 564550 8 0 0 0 0 0 0 0 0 000 14. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name: Certified Signature: Beth Farouse Title:Production Analyst Contact Phone:713-289-2627 Contact Email:bfarouse@hilcorp.com Revision? Date: Form 10-405 Rev. 04/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Tertiary gas Month and Year: JULY 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-01 50-883-20016-00-00 2 564570 8 0 99 0 0 0 0 0 0 A-02 50-883-20018-00-00 2 564570 1 30 112 0 8 2,963 0 232 88,886 A-03 50-883-20020-00-00 2 564570 8 0 0 0 0 0 0 0 0 A-04 50-883-20023-00-00 2 564570 8 0 0 0 0 0 0 0 0 A-05 50-883-20025-00-00 2 564570 1 31 96 0 45 5,738 0 1,400 177,882 A-06 50-883-20026-00-00 2 564570 8 0 256 0 0 0 0 0 0 A-07 50-883-20027-00-00 2 564570 8 0 214 0 0 0 0 0 0 A-08 50-883-20028-00-00 2 564570 8 0 195 0 0 0 0 0 0 A-09 50-883-20029-00-00 2 564570 8 0 639 0 0 0 0 0 0 A-10A 50-883-20030-01-00 2 564570 2 3 473 0 690 0 0 2,069 0 A-12 L 50-883-20032-00-00 2 564570 8 0 3 0 0 0 0 0 0 B-02 50-883-20090-01-00 2 564570 2 30 247 0 1 5,464 0 24 163,928 B-01A L 50-883-20093-01-00 2 564570 8 0 429 0 0 0 0 0 0 B-03 50-883-20095-00-00 2 564570 2 31 65 0 85 688 0 2,631 21,328 A-14 50-883-20125-00-00 2 564570 1 31 59 0 43 292 0 1,336 9,055 A-15 50-883-20126-00-00 2 564570 2 31 60 0 175 1,509 0 5,440 46,787 A-16 50-883-20127-00-00 2 564570 1 31 64 0 11 2,688 0 349 83,326 591,19213,4810 14. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name: Certified Signature: Beth Farouse Title:Production Analyst Contact Phone:713-289-2627 Contact Email:bfarouse@hilcorp.com Revision? Date: Form 10-405 Rev. 04/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY INJECTION REPORT 20 AAC 25.432 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Undefined WDSP Month and Year: JULY 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.9. MAX PSIG 10. AVG PSIG 11. LIQUID (BBL) 12. GAS (MCF) 13. LIQUID (BBL) 14. GAS (MCF) CASING PRESS.TUBING PRESS. 7. MAX PSIG 8. AVG PSIG DAILY AVG. INJ.TOTAL MONTHLY INJ. A-12 S 50-883-20032-00-00 5 564036 8 0 4 3 66 62 0 0 0 0 A-13 50-883-20087-00-00 5 564036 9 12 1,473 593 38 23 556 0 6,666 0 B-01A S 50-883-20093-01-00 5 564036 9 1 440 429 441 438 17,323 0 17,323 0 023,989 15. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name:Beth Farouse Title:Production Analyst Certified Signature:Contact Email:bfarouse@hilcorp.com Contact Phone:713-289-2627 Revision? Date: Form 10-406 Rev. 02/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT NET OIL SALES Hilcorp Alaska, LLC North Cook Inlet AUGUST 2021 Name of Operator Regulatory Lease Month and Year of Production Total Wells 18 Total Wells Produced 7 Total Pipeline Runs 0 Closing Inventory 0 Opening Inventory 0 Other Adjustments 0 (direct or xylene recovered) Total Net Production 0 I hereby certify that the foregoing is true and correct to the best of my knowledge. Signed 0 4,254 625,910 Beth Farouse TOTAL OIL WATER GAS Title Production Analystq Date:9/15/2021 STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Sterling, Undefined Gas Month and Year: AUGUST 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-03 50-883-20020-00-00 2 564550 8 0 0 0 0 0 0 0 0 000 14. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name: Certified Signature: Beth Farouse Title:Production Analystq Contact Phone:713-289-2627 Contact Email:bfarouse@hilcorp.com Revision? Date: Form 10-405 Rev. 04/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Tertiary gas Month and Year: AUGUST 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-01 50-883-20016-00-00 2 564570 8 0 100 0 0 0 0 0 0 A-02 50-883-20018-00-00 2 564570 1 31 98 0 2 3,596 0 77 111,477 A-03 50-883-20020-00-00 2 564570 8 0 0 0 0 0 0 0 0 A-04 50-883-20023-00-00 2 564570 8 0 0 0 0 0 0 0 0 A-05 50-883-20025-00-00 2 564570 1 31 88 0 4 5,125 0 128 158,869 A-06 50-883-20026-00-00 2 564570 8 0 256 0 0 0 0 0 0 A-07 50-883-20027-00-00 2 564570 8 0 317 0 0 0 0 0 0 A-08 50-883-20028-00-00 2 564570 8 0 200 0 0 0 0 0 0 A-09 50-883-20029-00-00 2 564570 8 0 640 0 0 0 0 0 0 A-10A 50-883-20030-01-00 2 564570 8 0 689 0 0 0 0 0 0 A-12 L 50-883-20032-00-00 2 564570 8 0 3 0 0 0 0 0 0 B-02 50-883-20090-01-00 2 564570 2 31 222 0 0 6,106 0 1 189,288 B-01A L 50-883-20093-01-00 2 564570 8 0 441 0 0 0 0 0 0 B-03 50-883-20095-00-00 2 564570 2 31 64 0 87 869 0 2,702 26,945 A-14 50-883-20125-00-00 2 564570 1 31 59 0 20 327 0 628 10,131 A-15 50-883-20126-00-00 2 564570 2 31 60 0 18 1,508 0 551 46,744 A-16 50-883-20127-00-00 2 564570 1 31 63 0 5 2,660 0 168 82,456 625,9104,2540 14. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name: Certified Signature: Beth Farouse Title:Production Analystq Contact Phone:713-289-2627 Contact Email:bfarouse@hilcorp.com Revision? Date: Form 10-405 Rev. 04/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY INJECTION REPORT 20 AAC 25.432 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Undefined WDSP Month and Year: AUGUST 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.9. MAX PSIG 10. AVG PSIG 11. LIQUID (BBL) 12. GAS (MCF) 13. LIQUID (BBL) 14. GAS (MCF) CASING PRESS.TUBING PRESS. 7. MAX PSIG 8. AVG PSIG DAILY AVG. INJ.TOTAL MONTHLY INJ. A-12 S 50-883-20032-00-00 5 564036 8 0 4 3 70 68 0 0 0 0 A-13 50-883-20087-00-00 5 564036 9 10 1,461 468 42 21 585 0 5,852 0 B-01A S 50-883-20093-01-00 5 564036 8 0 443 441 443 442 0 0 0 0 05,852 15. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Name:Beth Farouse Title:Production Analystq Certified Signature:Contact Email:bfarouse@hilcorp.com Contact Phone:713-289-2627 Revision? Date: Form 10-406 Rev. 02/2006 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT NET OIL SALES Hilcorp Alaska, LLC North Cook Inlet SEPTEMBER 2021 Name of Operator Regulatory Lease Month and Year of Production Total Wells 18 Total Wells Produced 7 Total Pipeline Runs 0 Closing Inventory 0 Opening Inventory 0 Other Adjustments 0 (direct or xylene recovered) Total Net Production 0 I hereby certify that the foregoing is true and correct to the best of my knowledge. Signed 0 1,993 596,916 Beth Farouse TOTAL OIL WATER GAS Title Production Analyst Date:10/17/2021 STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Sterling, Undefined Gas Month and Year: SEPTEMBER 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-03 50-883-20020-00-00 2 564550 8 0 0 0 0 0 0 0 0 00014. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Authorized Name and Digital Signature with date: Title:Production Analyst Contact Phone:713-289-2627 Contact Email:bfarouse@hilcorp.com Revision? Date of Revision: Form 10-405 Rev. 10/2021 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Tertiary gas Month and Year: SEPTEMBER 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-01 50-883-20016-00-00 2 564570 8 0 334 0 0 0 0 0 0 A-02 50-883-20018-00-00 2 564570 1 30 92 0 1 3,552 0 44 106,546 A-03 50-883-20020-00-00 2 564570 8 0 0 0 0 0 0 0 0 A-04 50-883-20023-00-00 2 564570 8 0 0 0 0 0 0 0 0 A-05 50-883-20025-00-00 2 564570 1 30 92 0 1 5,507 0 16 165,219 A-06 50-883-20026-00-00 2 564570 8 0 263 0 0 0 0 0 0 A-07 50-883-20027-00-00 2 564570 8 0 330 0 0 0 0 0 0 A-08 50-883-20028-00-00 2 564570 8 0 201 0 0 0 0 0 0 A-09 50-883-20029-00-00 2 564570 8 0 640 0 0 0 0 0 0 A-10A 50-883-20030-01-00 2 564570 8 0 810 0 0 0 0 0 0 A-12 L 50-883-20032-00-00 2 564570 8 0 4 0 0 0 0 0 0 B-02 50-883-20090-01-00 2 564570 2 30 202 0 0 5,807 0 0 174,214 B-01A L 50-883-20093-01-00 2 564570 8 0 443 0 0 0 0 0 0 B-03 50-883-20095-00-00 2 564570 2 30 63 0 42 928 0 1,251 27,843 A-14 50-883-20125-00-00 2 564570 1 30 58 0 11 305 0 333 9,139 A-15 50-883-20126-00-00 2 564570 2 30 59 0 9 1,293 0 266 38,783 A-16 50-883-20127-00-00 2 564570 1 30 62 0 3 2,506 0 82 75,173 596,9161,993014. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Authorized Name and Digital Signature with date: Title:Production Analyst Contact Phone:713-289-2627 Contact Email:bfarouse@hilcorp.com Revision? Date of Revision: Form 10-405 Rev. 10/2021 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY INJECTION REPORT 20 AAC 25.432 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Undefined WDSP Month and Year: SEPTEMBER 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.9. MAX PSIG 10. AVG PSIG 11. LIQUID (BBL) 12. GAS (MCF) 13. LIQUID (BBL) 14. GAS (MCF) CASING PRESS.TUBING PRESS. 7. MAX PSIG 8. AVG PSIG DAILY AVG. INJ.TOTAL MONTHLY INJ. A-12 S 50-883-20032-00-00 5 564036 8 0 4 4 70 66 0 0 0 0 A-13 50-883-20087-00-00 5 564036 9 17 1,469 706 24 8 359 0 6,109 0 B-01A S 50-883-20093-01-00 5 564036 8 0 452 443 451 443 0 0 0 0 06,10915. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Title:Production Analyst Authorized Name and Digital Signature with date: Contact Email:bfarouse@hilcorp.com Contact Phone:713-289-2627 Revision? Date of Revision: Form 10-406 Rev. 10/2021 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT NET OIL SALES Hilcorp Alaska, LLC North Cook Inlet OCTOBER 2021 Name of Operator Regulatory Lease Month and Year of Production Total Wells 18 Total Wells Produced 8 Total Pipeline Runs 0 Closing Inventory 0 Opening Inventory 0 Other Adjustments 0 (direct or xylene recovered) Total Net Production 0 I hereby certify that the foregoing is true and correct to the best of my knowledge. Signed 0 2,480 614,793 Beth Farouse TOTAL OIL WATER GAS Title Production Analyst Date:11/17/2021 STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Sterling, Undefined Gas Month and Year: OCTOBER 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-03 50-883-20020-00-00 2 564550 8 0 169 0 0 0 0 0 0 00014. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Authorized Name and Digital Signature with date: Title:Production Analyst Contact Phone:713-289-2627 Contact Email:bfarouse@hilcorp.com Revision? Date of Revision: Form 10-405 Rev. 10/2021 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Tertiary gas Month and Year: OCTOBER 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-01 50-883-20016-00-00 2 564570 8 0 5 0 0 0 0 0 0 A-02 50-883-20018-00-00 2 564570 1 31 90 0 3 3,564 0 78 110,497 A-03A 50-883-20020-00-00 2 564570 1 3 169 0 0 2,782 0 0 8,345 A-04 50-883-20023-00-00 2 564570 8 0 5 0 0 0 0 0 0 A-05 50-883-20025-00-00 2 564570 1 31 89 0 2 5,754 0 53 178,376 A-06 50-883-20026-00-00 2 564570 8 0 270 0 0 0 0 0 0 A-07 50-883-20027-00-00 2 564570 8 0 330 0 0 0 0 0 0 A-08 50-883-20028-00-00 2 564570 8 0 201 0 0 0 0 0 0 A-09 50-883-20029-00-00 2 564570 8 0 640 0 0 0 0 0 0 A-10A 50-883-20030-01-00 2 564570 8 0 928 0 0 0 0 0 0 A-12 L 50-883-20032-00-00 2 564570 8 0 3 0 0 0 0 0 0 B-02 50-883-20090-01-00 2 564570 2 31 188 0 0 5,770 0 0 178,868 B-01A L 50-883-20093-01-00 2 564570 8 0 444 0 0 0 0 0 0 B-03 50-883-20095-00-00 2 564570 2 7 739 0 83 759 0 581 5,315 A-14 50-883-20125-00-00 2 564570 1 31 55 0 26 426 0 798 13,196 A-15 50-883-20126-00-00 2 564570 2 31 56 0 24 1,329 0 729 41,186 A-16 50-883-20127-00-00 2 564570 1 31 59 0 8 2,549 0 241 79,009 614,7932,480014. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Authorized Name and Digital Signature with date: Title:Production Analyst Contact Phone:713-289-2627 Contact Email:bfarouse@hilcorp.com Revision? Date of Revision: Form 10-405 Rev. 10/2021 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY INJECTION REPORT 20 AAC 25.432 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Undefined WDSP Month and Year: OCTOBER 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.9. MAX PSIG 10. AVG PSIG 11. LIQUID (BBL) 12. GAS (MCF) 13. LIQUID (BBL) 14. GAS (MCF) CASING PRESS.TUBING PRESS. 7. MAX PSIG 8. AVG PSIG DAILY AVG. INJ.TOTAL MONTHLY INJ. A-12 S 50-883-20032-00-00 5 564036 8 0 4 3 65 56 0 0 0 0 A-13 50-883-20087-00-00 5 564036 9 14 1,446 638 50 15 411 0 5,754 0 B-01A S 50-883-20093-01-00 5 564036 8 0 447 444 447 444 0 0 0 0 05,75415. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Title:Production Analyst Authorized Name and Digital Signature with date: Contact Email:bfarouse@hilcorp.com Contact Phone:713-289-2627 Revision? Date of Revision: Form 10-406 Rev. 10/2021 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT NET OIL SALES Hilcorp Alaska, LLC North Cook Inlet NOVEMBER 2021 Name of Operator Regulatory Lease Month and Year of Production Total Wells 19 Total Wells Produced 10 Total Pipeline Runs 0 Closing Inventory 0 Opening Inventory 0 Other Adjustments 0 (direct or xylene recovered) Total Net Production 0 I hereby certify that the foregoing is true and correct to the best of my knowledge. Signed 0 3,307 947,274 Beth Farouse TOTAL OIL WATER GAS Title Production Analyst Date:12/16/2021 STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Sterling, Undefined Gas Month and Year: NOVEMBER 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-03 50-883-20020-00-00 2 564550 8 0 288 0 0 0 0 0 0 00014. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Authorized Name and Digital Signature with date: Title:Production Analyst Contact Phone:713-289-2627 Contact Email:bfarouse@hilcorp.com Revision? Date of Revision: Form 10-405 Rev. 10/2021 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Tertiary gas Month and Year: NOVEMBER 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-01A 50-883-20016-00-00 2 564570 1 19 235 0 0 3,448 0 0 65,507 A-02 50-883-20018-00-00 2 564570 1 30 96 0 5 3,171 0 157 95,126 A-03A 50-883-20020-00-00 2 564570 1 30 288 0 1 5,930 0 44 177,910 A-04 50-883-20023-00-00 2 564570 8 0 247 0 0 0 0 0 0 A-04A 50-883-20023-01-00 2 564570 1 28 247 0 0 5,316 0 8 148,843 A-05 50-883-20025-00-00 2 564570 1 30 88 0 1 5,335 0 38 160,046 A-06 50-883-20026-00-00 2 564570 8 0 272 0 0 0 0 0 0 A-07 50-883-20027-00-00 2 564570 8 0 330 0 0 0 0 0 0 A-08 50-883-20028-00-00 2 564570 8 0 206 0 0 0 0 0 0 A-09 50-883-20029-00-00 2 564570 8 0 640 0 0 0 0 0 0 A-10A 50-883-20030-01-00 2 564570 8 0 856 0 0 0 0 0 0 A-12 L 50-883-20032-00-00 2 564570 8 0 3 0 0 0 0 0 0 B-02 50-883-20090-01-00 2 564570 2 30 180 0 0 5,677 0 0 170,310 B-01A L 50-883-20093-01-00 2 564570 8 0 175 0 0 0 0 0 0 B-03 50-883-20095-00-00 2 564570 2 7 645 0 138 479 0 964 3,351 A-14 50-883-20125-00-00 2 564570 1 30 57 0 45 398 0 1,342 11,926 A-15 50-883-20126-00-00 2 564570 2 30 58 0 15 1,389 0 438 41,666 A-16 50-883-20127-00-00 2 564570 1 30 61 0 10 2,420 0 315 72,590 947,2743,307014. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Authorized Name and Digital Signature with date: Title:Production Analyst Contact Phone:713-289-2627 Contact Email:bfarouse@hilcorp.com Revision? Date of Revision: Form 10-405 Rev. 10/2021 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY INJECTION REPORT 20 AAC 25.432 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Undefined WDSP Month and Year: NOVEMBER 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.9. MAX PSIG 10. AVG PSIG 11. LIQUID (BBL) 12. GAS (MCF) 13. LIQUID (BBL) 14. GAS (MCF) CASING PRESS.TUBING PRESS. 7. MAX PSIG 8. AVG PSIG DAILY AVG. INJ.TOTAL MONTHLY INJ. A-12 S 50-883-20032-00-00 5 564036 8 0 3 3 45 36 0 0 0 0 A-13 50-883-20087-00-00 5 564036 9 6 1,391 277 206 36 548 0 3,287 0 B-01A S 50-883-20093-01-00 5 564036 8 0 445 175 446 444 0 0 0 0 03,28715. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Title:Production Analyst Authorized Name and Digital Signature with date: Contact Email:bfarouse@hilcorp.com Contact Phone:713-289-2627 Revision? Date of Revision: Form 10-406 Rev. 10/2021 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT NET OIL SALES Hilcorp Alaska, LLC North Cook Inlet DECEMBER 2021 Name of Operator Regulatory Lease Month and Year of Production Total Wells 19 Total Wells Produced 10 Total Pipeline Runs 0 Closing Inventory 0 Opening Inventory 0 Other Adjustments 0 (direct or xylene recovered) Total Net Production 0 I hereby certify that the foregoing is true and correct to the best of my knowledge. Signed 0 6,129 1,004,844 Leanne Watkins TOTAL OIL WATER GAS Title N/A Date:1/20/2022 STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Sterling, Undefined Gas Month and Year: DECEMBER 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-03 50-883-20020-00-00 2 564550 8 0 266 0 0 0 0 0 0 00014. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Authorized Name and Digital Signature with date: Title:N/A Contact Phone:N/A Contact Email:N/A Revision? Date of Revision: Form 10-405 Rev. 10/2021 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate Heather Chapa 01/20/2022 STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY PRODUCTION REPORT 20 AAC 25.230 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Tertiary gas Month and Year: DECEMBER 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.7. Avg. FTP psig (see instruct.) 8. OIL (BBL) 9. WATER (BBL) 10. GAS (MCF) 11. OIL (BBL) 12. WATER (BBL) 13. GAS (MCF) TOTAL MONTHLY PRODUCTIONDAILY AVG. PRODUCTION A-01A 50-883-20016-00-00 2 564570 1 31 92 0 0 3,000 0 9 93,008 A-02 50-883-20018-00-00 2 564570 1 31 97 0 5 3,127 0 150 96,931 A-03A 50-883-20020-00-00 2 564570 1 31 266 0 1 6,173 0 18 191,360 A-04 50-883-20023-00-00 2 564570 8 0 251 0 0 0 0 0 0 A-04A 50-883-20023-01-00 2 564570 1 31 251 0 0 5,711 0 14 177,033 A-05 50-883-20025-00-00 2 564570 1 31 86 0 1 4,856 0 30 150,545 A-06 50-883-20026-00-00 2 564570 8 0 272 0 0 0 0 0 0 A-07 50-883-20027-00-00 2 564570 8 0 333 0 0 0 0 0 0 A-08 50-883-20028-00-00 2 564570 8 0 201 0 0 0 0 0 0 A-09 50-883-20029-00-00 2 564570 8 0 639 0 0 0 0 0 0 A-10A 50-883-20030-01-00 2 564570 8 0 137 0 0 0 0 0 0 A-12 L 50-883-20032-00-00 2 564570 8 0 3 0 0 0 0 0 0 B-02 50-883-20090-01-00 2 564570 1 31 146 0 4 5,370 0 126 166,480 B-01A L 50-883-20093-01-00 2 564570 8 0 106 0 0 0 0 0 0 B-03 50-883-20095-00-00 2 564570 2 29 89 0 111 20 0 3,210 576 A-14 50-883-20125-00-00 2 564570 2 31 59 0 43 358 0 1,327 11,093 A-15 50-883-20126-00-00 2 564570 1 31 60 0 10 1,419 0 323 43,984 A-16 50-883-20127-00-00 2 564570 1 31 63 0 30 2,382 0 921 73,835 1,004,8446,129014. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Authorized Name and Digital Signature with date: Title:N/A Contact Phone:N/A Contact Email:N/A Revision? Date of Revision: Form 10-405 Rev. 10/2021 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate Heather Chapa 01/20/2022 STATE OF ALASKA ALASKA OIL AND GAS CONSERVATION COMMISSION MONTHLY INJECTION REPORT 20 AAC 25.432 Name of Operator: HILCORP ALASKA, LLC Field and Pool: North Cook Inlet, North Cook Inlet, Undefined WDSP Month and Year: DECEMBER 2021 1. Well No.2. API No. 50-XXX-XXXXX-XX-XX 3. Type (see instruct.) 4. Field & Pool Code 5. Method (see instruct.) 6. Days in Oper.9. MAX PSIG 10. AVG PSIG 11. LIQUID (BBL) 12. GAS (MCF) 13. LIQUID (BBL) 14. GAS (MCF) CASING PRESS.TUBING PRESS. 7. MAX PSIG 8. AVG PSIG DAILY AVG. INJ.TOTAL MONTHLY INJ. A-12 S 50-883-20032-00-00 5 564036 8 0 3 3 22 19 0 0 0 0 A-13 50-883-20087-00-00 5 564036 9 10 1,384 454 341 125 431 0 4,315 0 B-01A S 50-883-20093-01-00 5 564036 8 0 114 106 456 445 0 0 0 0 04,31515. TOTAL I hereby certify that the foregoing is true and correct to the best of my knowledge. Title:N/A Authorized Name and Digital Signature with date: Contact Email:N/A Contact Phone:N/A Revision? Date of Revision: Form 10-406 Rev. 10/2021 INSTRUCTIONS ON REVERSE SIDE Submit in duplicate Heather Chapa 01/20/2022