Form 3160-4 - Well Completion Or Recompletion Report And Log

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Form 3160-4
UNITED STATES
(June 2015)
FORM APPROVED
DEPARTMENT OF THE INTERIOR
OMB NO. 1004-0137
BUREAU OF LAND MANAGEMENT
Expires: January 31, 2018
WELL COMPLETION OR RECOMPLETION REPORT AND LOG
5. Lease Serial No.
6. If lndian, Allottee or Tribe Name
1a. Type of Well
Oil Well
Gas Well
Dry
Other
b. Type of Competion
New Well
Work Over
Deepen
Plug Back
Diff. Zones
Hydraulic Fracturing
7. Unit or CA Agreement Name and No.
Other:
8. Lease Name and Well No.
2. Name of Operator
3. Address
3a. Phone No. (Include area code)
9. API Well No.
10. Field and Pool or Exploratory
4. Location of Well (Report location clearly and in accordance with Federal requirements)*
At surface
11. Sec., T., R., M., on Block and
Survey or Area
At top prod. interval reported below
12. County or Parish
13. State
At total depth
16. Date Completed
17. Elevations (DF, RKB, RT, GL)*
14. Date Spudded
15. Date T.D. Reached
D & A
Ready to Prod.
MD
MD
18. Total Depth: MD
19. Plug Back T.D.:
20. Depth Bridge Plug Set:
TVD
TVD
TVD
21. Type Electric & Other Mechanical Logs Run (Submit copy of each)
22. Was well cored?
No
Yes (Submit analysis)
No
Yes (Submit report)
Was DST run?
Directional Survey?
No
Yes (Submit copy)
23. Casing and Liner Record (Report all strings set in well)
Stage Cementer
No. of Sks. &
Slurry Vol.
Hole Size
Size/Grade
Wt. (#ft.)
Top (MD)
Bottom (MD)
Cement Top*
Amount Pulled
Depth
Type of Cement
(BBL)
24. Tubing Record
Size
Dept Set (MD)
Packer Dept (MD)
Size
Depth Set (MD)
Packer Depth (MD)
Size
Depth Set (MD)
Packer Depth (MD)
25. Producing Intervals
26. Perforation Record
Formation
Top
Bottom
Perforated Interval
Size
No. Holes
Perf. Status
A)
B)
C)
D)
27. Acid, Fracture, Treatment, Cement Squeeze, Post hydraulic fracturing chemical disclosures on
Depth Interval
Amount, Type of Material and Date of Chemical Disclosure upload on
28. Production - Interval A
Oil
Date First
Test Date Hours
Test
Gas
Water
Oil Gravity
Gas
Production Method
Produced
Tested
Production
BBL
MCF
BBL
Corr. API.
Gravity
Choke
Tbg. Press.
Csg.
24 Hr.
Oil
Gas
Water
Gas/Oil
Well Status
Size
Flwg.
Press.
Rate
BBL
MCF
BBL
Ratio
SI
28a. Production - Interval B
Oil
Date First
Test Date Hours
Test
Gas
Water
Oil Gravity
Gas
Production Method
Produced
Tested
Production
BBL
MCF
BBL
Corr. API.
Gravity
Choke
Tbg. Press.
Csg.
24 Hr.
Oil
Gas
Water
Gas/Oil
Well Status
Size
Flwg.
Press.
Rate
BBL
MCF
BBL
Ratio
SI
*(See instructions and spaces for additional data on page 2)

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