Form 3260-4 - Geothermal Well Completion Report
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Form 3260-4
UNITED STATES
FORM APPROVED
(April 2011)
OMB
NO. 1004-0132
DEPARTMENT OF THE INTERIOR
Expires: December 31, 2013
BUREAU OF LAND MANAGEMENT
4. Lease Serial No.
GEOTHERMAL WELL COMPLETION REPORT
5. Surface Manager:
BLM
FS
The Bureau of Land Management (BLM) requires this form or other BLM-approved forms to be prepared
Other
and filed in duplicate with requisite attachments within 30 days after the completion of permitted operations.
la. Well Type
Production
Injection
Disposal
Water Supply
Observation
6. Unit Agreement Name
Cold
Heat Exchange
Other
1b. Type of Completion:
New
Workover
Deepened
Plugback
Redrill
7. Well No.
8. Permit No.
Recompleted
Drilled & Abandoned
Other
2. Name of Lessee/Operator
9. Field or Area
10. Sec., T., R., B. & M.
3. Address of Lessee/Operator
11. County
12. State
18. Location of Well
13. Spud Date
Date T.D. Reached
At surface:
At Top of Production Zone:
At Total Depth:
19. Total Depth
14. Completion Date (ready to produce)
Measured:
True Vertical:
15. Directionally Drilled Intervals
20. Plugback Total Depth
Measured:
True Vertical:
16. Surveyed Intervals
21. Elevation:
Estimated
Final
Reference Datum:
GR
MAT
DF
KB
RT
Casinghead Flange
Other
22. Drilling Media:
Air
Water
Mud
Foam
Other
17. Core Size and Intervals
List characteristics
23. Log Type & Intervals
24. CASING RECORD
Depths Set
Cementing Record
Size
Weight
Grade
Collars & Threads
Hole Size
Top
SHoe
(slurry volume)
25. LINER RECORD
Cementing Record
Size
Weight
Grade
Collars & Threads
Top
Bottom
Perforated Intervals
(slurry volume)
26. TUBING RECORD
27. Cement Squeeze, Acid, Fracture, etc (detail type, amount, intervals)
Size
Weight
Grade
Depth Set
Packer Depth
28. PERFORATION RECORD
Type
Total No.
Density (No./ft)
Size
Intervals
29. Attachments & Previous Submittals: List all reports, surveys, tests and logs, not listed in item 23, which have resulted from drilling and completion operations. List relevant previously
furnished data with date of submittal referenced.
30. Well Status:
Producing
Shut-In
Suspended
Injection
Disposal
Heat Exchange
Abandoned
Water Supply
Other
31. Do you consider the well to be commercial?
Yes
No
Explain:
32. I hereby certify the information on this report and the attached information is complete and accurate according to the best of my knowledge.
Signed______________________________________________________
Title _______________________________________________
Date ____________________________
18 U.S.C.
43 U.S.C
for
to
or
of
any false,
Title
Section 1001 and Title
Section 1212 make it a crime
any person knowingly and willfully
make to any department
agency
the United States
fictitious or fraudulent statements or representations as to any matter within its jurisdiction.
(Continued on page 2)
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