STATE OIL AND GAS BOARD OF ALABAMA
OGB-1A
Application to Reenter
01
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_______________________________________
____________________________________________
Permit Number
(
)
API Number
To be filled in by Board
Form OGB-1A, Rev. 07/13
Drill
Deepen
Amend
(File in triplicate)
Name of Operator ___________________________________________________________ Date ____________________________________
Address _______________________________________________ City _____________________ State ____________ Zip _______________
1. Well name and number
2. County
(give footage from nearest section or offshore tract lines)
Section-Township-Range or Tract
Well
3.
Location
Latitude
Longitude
▪
▪
(actual surface)
(NAD27)
(NAD27)
4. Field (If wildcat, so state)
5. Target Reservoir
6. Unit assigned to well
7. Distance from proposed
8. Distance (if less than 5,280 feet) from proposed location to
location to nearest unit line
feet
nearest permitted, drilling, or producible well in same reservoir
feet
9. Proposed depth
10. Approximate date work will begin
11. Anticipated depth to base of fresh
water (<10,000 mg/L TDS), if known
subsea depth
12. Acres assigned to well
13. Elevation (ground)
14. Is an alternate unit required in accordance
Yes
No
with the applicable spacing rule?
(If yes, see no. 15 below)
15. If yes, describe alternate unit in
accordance with applicable rule
16. Type
Single Well
Amount of bond
17. Bonding company and bond number
bond
Blanket
18. Are the provisions of Rule 400-1-9-.02 or Rule 400-2-8-.04, Operations Involving Hydrogen Sulfide, applicable?
Yes
No
If yes, a Form OGB-24 shall be filed with this application.
19. Person to contact regarding
Phone Number
this application
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,
ACTION OF STATE OIL AND GAS BOARD
APPROVED BY
DATE
_________________________________________________
_____________________________________