Form OGB-7
________________________
(Page 2)
Permit Number
TUBING RECORD
Size
Weight/ft.
Name & Type
Depth set
__________________
_________________
____________________________________
______________________________________
__________________
_________________
____________________________________
______________________________________
___________________
_________________
____________________________________
______________________________________
PACKER RECORD
Size (O.D.)
Size (I.D.)
Name & Type
Depth set
Date
Test pressure
______________
_____________
___________________________
_______________
_______________
_________________
______________
_____________
___________________________
_______________
_______________
_________________
______________
_____________
___________________________
_______________
_______________
_________________
MECHANICAL PLUG
Size
Weight range
Name & Type
Depth set
Date
Test pressure
______________
_____________
___________________________
_______________
_______________
_________________
______________
_____________
___________________________
_______________
_______________
_________________
______________
_____________
___________________________
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_______________
_________________
WELL STIMULATION AND TREATMENT RECORD*
Process
Interval
Date
Material & Quantity
Pressure
Service company
____________
___________to___________
_________
_______________________
_________
_________________________
____________
___________to___________
_________
_______________________
_________
_________________________
____________
___________to___________
_________
_______________________
_________
_________________________
____________
___________to___________
_________
_______________________
_________
_________________________
* Full details should be given on Form OGB-6, Report of Well Treatment.
DRILL STEM TEST RECORD**
Test date
Interval
Type and volume of fluids recovered (oil, gas, water, etc.)
______________
____________to____________
_____________________________________________ ; Rw = _____________________
______________
____________to____________
_____________________________________________ ; Rw = _____________________
______________
____________to____________
_____________________________________________ ; Rw = _____________________
______________
____________to____________
_____________________________________________ ; Rw = _____________________
** Submit two copies of drill stem test results with this form.
ARTIFICIAL LIFT
Date installed: _________________________________
Type: ______________________________
Depth: __________________________
Person to contact regarding this form
Phone number
Fax number
E-mail Address
Remarks:
__________
________
___________________________________________________
Executed this the _______ day of __________
, 20 __
Signature
________________________________________
Before me, the undersigned authority, on this day personally appeared
known to me to be the person
whose name is subscribed to the above instrument, who being by me duly sworn on oath states that he/she is duly authorized to make the above report and that he/she
has knowledge of the facts stated therein, and that said report is true and correct.
_______
____________________
_________
Subscribed and sworn to before me this
day of
, 20
_____________________________________
_____________________
SEAL
Notary Public in and for
____________________
My commission expires
________________________________
County,