Form 3260-2 - Geothermal Drilling Permit
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UNITED STATES
FORM APPROVED
Form 3260-2
DEPARTMENT OF THE INTERIOR
OMB NO. 1004-0132
(
20 )
Expires:
31, 201
BUREAU OF LAND MANAGEMENT
7. Lease Serial No.
GEOTHERMAL DRILLING PERMIT
The Bureau of Land Management (BLM) requires this form or other BLM approved forms to be prepared and filed in
8. Surface Manager:
BLM
FS
triplicate with requisite attachments. The BLM must approve this permit prior to any lease operation.
Other
1a. Type of Work:
Drill New Well
Redrill
Deepen
Plug Back
Directionally Drill
Other
9. Unit Agreement Name
1b. Well Type:
Production
Injection
Heat Exchange
Observation
Water Supply
Other
10. Well No.
11. Permit No.
1c. Well Status:
12. Field or Area
2. Name of Lessee/Operator
13. Sec., T., R., B. & M.
3. Address of Lessee/Operator
4. Location of Well
14. County
At surface
15. State
At proposed prod. Zone
5. Distance from Proposed Location to Nearest Property or Lease Line
16. Approx. Starting Date
6. Distance from Proposed Location to Nearest Well or Previously Applied for Well Location on this Lease.
17. Acres Assigned (Well Spacing)
18. Drilling Media and Characteristics:
Air
19. Proposed Depth
20. Elevations:
Estimated
Final
Water
Mud
Foam
Other
Measured:
Reference Datum:
GR
MAT
DF
KB
RT
True Vertical:
Casinghead Flange
Other
21. Existing and/or Proposed Casing and Cementing Program (List existing program first, followed by proposed program and separate by a sufficient space to clearly distinguish the two programs)
COUPLING
SETTING DEPTH
SIZE OF HOLE
SIZE OF CASING
WEIGHT PER FOOT
GRADE
QUANTITY OF CEMENT
Top
Bottom
(Collars & Threads)
22. Proposed Work Summary
23.
____________________________________________________________
____________________________________________________
_______________________________
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
any
Title
Section 1001 and Title
Section 1212 make it a crime
any person knowingly and willfully
make to any department
agency
the United States
false, fictitious or fraudulent statements or representations as to any matter within its jurisdiction.
(Continued on page 2)
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