Form 3160-4 - Well Completion Or Recompletion Report And Log Page 2

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28b. Production - Interval C
Date First
Test Date Hours
Test
Oil
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
28c. Production - Interval D
Date First
Test Date Hours
Test
Oil
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
29. Disposition of Gas (Solid, used for fuel, vented, etc.)
30. Summary of Porous Zones (Include Aquifers):
31. Formation (Log) Markers
Show all important zones of porosity and contents thereof: Cored intervals and all drill-stem tests,
including depth interval tested, cushion used, time tool open, flowing and shut-in pressures and
recoveries.
Top
Formation
Top
Bottom
Descriptions, Contents, etc.
Name
Meas. Depth
32. Additional remarks (include plugging procedure).
33. Indicate which items have been attached by placing a check in the appropriate boxes:
Electrical/Mechanical Logs (1 full set req’d.)
Geologic Report
DST Report
Directional Survey
Sundry Notice for plugging and cement verification
Core Analysis
Other:
34. I hereby certify that the foregoing and attached information is complete and correct as determined from all available records (see attached instructions)*
Name (please print)
Title
Signature
Date
Title 18 U.S C. Section 1001 and Title 43 U.S C. Section 1212, make it a crime for any person knowingly and willfully to make to any department or agency of the United States any
false, fictitious or fraudulent statements or representations as to any matter within its jurisdiction.
(Continued on page 3)
(Form 3160-4, page 2)

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