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RAILROAD COMMISSION OF TEXAS

Form P-17

Rev. 04/2015

1701 N. Congress

P.O. Box 12967

New

Austin, Texas 78701-2967

Amended Existing Permit No.____

APPLICATION FOR EXCEPTION TO

Effective Month/Year of Requested

Exception: _______ / _________

STATEWIDE RULES (SWR) 26 AND/OR 27

District __________

County __________

SECTION 1. OPERATOR INFORMATION

Operator Name:

Operator P-5 No.:

Operator Address:

SECTION 2. GATHERER (of oil or condensate) INFORMATION (not required if 3b is checked)

Gatherer Name:

Gatherer P-5 No.:

Gatherer Address:

Gatherer E-mail Address:

(Optional – If provided, e-mail address will become part of this public record.)

SECTION 3. APPLICATION APPLIES TO (CHECK ALL THAT APPLY):

OIL

CASINGHEAD GAS

GAS WELL GAS

CONDENSATE

Gas well full well stream into common separation and storage facility with liquids reported on Form PR.

Gas well full well stream into a gasoline plant/common separation and storage facility with liquids reported on

Form R-3 Serial #___________ (If full well stream is checked, the results of periodic tests to determine the number of stock tank barrels of

liquid hydrocarbons recovered per 1,000 standard cubic feet of gas must be reported on Form G-10 in accordance with SWR 55. Attach an

explanation of any exceptions to SWR 55.)

Condensate and low-pressure Gas Well Gas are commingled into low-pressure separation and storage facilities.

This request is for off lease:

Storage

Separation

Metering

This exception is for common storage.

This exception is for common separation.

This exception is for casinghead gas metering by:

Deduct Metering

Allocation by well test

Other__________

This exception is for gas well gas metering by:

Deduct Metering

Allocation by well test

Other__________

SECTION 4. NOTICE REQUIREMENTS AND ALLOCATION METHOD. (CHECK ALL THAT APPLY)

The following questions determine if 21-day notice is required and applies to all wells proposed for commingling:

The production is measured separately from all leases or individual wells before commingling. (Notice not required; Skip to Section 5)

The royalty interests and working interests are the same with respect to identity and percentage. (Notice not required)

The royalty interests and working interests are not the same with respect to identity and percentage. (Notice required)

If b. or c. checked, production will be allocated by:

W-10 (oil)

W-2 retest (oil)

PD Meter (oil & condensate)

G-10 (gas)

The wells produce from multiple reservoirs. (Notice required unless 4e. or 4f. apply; see instructions for additional requirements)

The wells produce from multiple reservoirs and have SWR10 exceptions. (Notice not required)

The wells produce from multiple reservoirs and are measured separately from each reservoir. (Notice not required)

Any one of the wells proposed for commingling produces from a Commission-designated reservoir for which special field rules have been

adopted. (Notice required)

SECTION 5.

Wells proposed for commingling have an operator’s name other than the applicant listed in SECTION 1. (See instructions)

SECTION 6.

For oil production, the production from all oil wells on each oil lease is to be commingled. (See instructions)

SECTION 7. IDENTIFY LEASES AS SHOWN ON COMMISSION RECORDS (attach additional pages as needed)

DISTRICT

RRC IDENTIFIER

ACTION

LEASE AND FIELD NAME

WELL NO.

Existing

Add

Delete

Existing

Add

Delete

Existing

Add

Delete

Existing

Add

Delete

ATTACH ADDITIONAL PAGES AS NEEDED.

No additional pages

Additional pages ____ (# of additional pages)

FEE: $150 Filing Fee + $225 Surcharge = $375 total remittance required (See Statewide Rule 78)

CERTIFICATE: I declare under penalties in Sec. 91.143, Texas Natural Resources Code, that I am authorized to file this application, that this application was prepared by me or

under my supervision and direction, and that the data and facts stated therein are true, correct, and complete to be the best of my knowledge. I certify that all requests for

related required approvals from other affected state agencies have been submitted and that I understand that any authorization granted by Commission approval of this

application is contingent upon the approvals from other affected state agencies being obtained.

Signature_______________________________________Title_________________________________________Date______________

Operator E-mail Address: ________________________________________________Operator Phone No. ________________________

(Optional – If provided, e-mail address will become part of this public record.)

R R C U S E O N L Y

Commingling Permit No._________________

Approval date:________________________

Approved by:________________________

Form P-17 - Application For Exception To Statewide Rules (Swr) 26 And/or 27 - Railroad Commission Of Texas

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