Form 3260-3 - Geothermal Sundry Notice
Download a blank fillable Form 3260-3 - Geothermal Sundry Notice in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 3260-3 - Geothermal Sundry Notice with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2Print
Reset
UNITED STATES
Form 3260-3
FORM APPROVED
DEPARTMENT OF THE INTERIOR
(April 2011)
OMB NO. 1004-0132
Expires: December 31, 2013
BUREAU OF LAND MANAGEMENT
6. Lease Serial No.
GEOTHERMAL SUNDRY NOTICE
7. Surface Manager:
BLM
FS
The Bureau of Land Management (BLM) requires this form or other BLM approved forms to be prepared and
Other
filed in triplicate with requisite attachments. The BLM must approve this permit prior to any lease operations.
8. Unit Agreement Name
1a. Well Type:
Production
Injection
Heat Exchange
Observation
Other
9. Well No.
10. Permit No.
1b. Well Status:
11. Field or Area
2. Name of Lessee/Operator
12. Sec., T., R., B. & M.
3. Address of Lessee/Operator
13. County
4. Location of Well or Facility
14. State
5. Type of Work
Change Plans
Convert to Injection
Pull or Alter Casing
Site and Road Construction
Fracture Test
Multiple Complete
Construct New Production Facilities
Shoot or Acidize
Abandon
Alter Existing Production Facilities
Repair Well
Other
15. Describe Proposed Operations (Use this space for well activities only. See instructions for current well conditions on page 2.)
16. Describe Proposed Operations (Use this space for activities other than well work.)
17. I hereby certify that the foregoing is true and correct.
Signed______________________________________________________
Title _______________________________________________
Date ___________________________
(This space for Federal use)
Approved by _________________________________________________
Title _______________________________________________
Date __________________________
Conditions of Approval, if any:
18 U.S.C.
43 U.S.C.
for
to
or
of
Title
Section 1001 and Title
Section 1212 make it a crime
any person knowingly and willfully
make to any department
agency
the United States
any false, fictitious or fraudulent statements or representations as to any matter within its jurisdiction.
(Continued on page 2)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal