MMS-124 - Application for Permit to Modify

Form 124 exp 11-11.xls

30 CFR 250, Increased Safety Measures for Oil and Gas Drilling, Well Completion, Operations

MMS-124 - Application for Permit to Modify

OMB: 1010-0185

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Overview

MMS-124 pg 1
MMS-124 pg 2


Sheet 1: MMS-124 pg 1

U.S. Department of the Interior
Submit original plus THREE copies,with ONE copy marked "Public Information."


OMB Control No. 1010-0141






















Bureau of Ocean Energy Management,


OMB Approval Expires 11/30/11






















Regulation and Enforcement (BOEMRE)





































Application for Permit to Modify (APM)






















1. WELL NAME (CURRENT) 2. SIDETRACK NO. (CURRENT) 3. BYPASS NO. (CURRENT) 4. OPERATOR NAME and ADDRESS






















(Submitting office)






















5. API WELL NO. (12 digits) 6. START DATE (Proposed) 7. ESTIMATED DURATION (DAYS)






















8. 9. If revision, please list changes:























Revision
















































WELL AT TOTAL DEPTH WELL AT SURFACE






















10. LEASE NO. 13. LEASE NO.






















11. AREA NAME 14. AREA NAME






















12. BLOCK NO. 15. BLOCK NO.






















Proposed or Completed Work






















16. PROPOSED OR COMPLETED WORK (Describe in Section 17)






















PLEASE SELECT ONLY ONE PRIMARY TYPE IN BOLD AND AS MANY SECONDARY TYPES AS NECESSARY.























Enhance Production
Workover:


Completion:




























Acidize


Change Tubing


Initial Completion


























Artifical Lift


Casing Pressure Repair

Reperforation


























Wash/Desand Well







Change Zone


























Jet Well

Abandonment of Well Bore:

Modify Perforations

























Utility


Permanent Abandonment






























Initial Injection Well

Temporary Abandonment
Information:




























Additional Fluids for Injection

Plugback to Sidetrack/Bypass

Surface Location Plat

























Other Operations

Site Clearance


Change Well Name


























Describe Operation(s)









































































17. BRIEFLY DESCRIBE PROPOSED OPERATIONS (Attach prognosis):























18. LIST ALL ATTACHMENTS (Attach complete well prognosis and attachments required by 30 CFR 250.513(a) through (d); 250.613(a) through (d); 250.1712(a) through (g); 250.1721(a) through (h); 250.1722(a) through (d); or 250.1743(a).



























































































19. Rig Name or Primary Unit (e.g., Wireline Unit, Coil Tubing, Snubbing Unit, etc.)






















20. The greater of SITP or MASP (psi):


21. Type of Safety Valve (SV): ___ SCSSV ___SSCSV ___ N/A







22. SV Depth BML (ft): ______
























23. Rig BOP (Rams)



24. Rig BOP (Annular)






















Size:
Working Pressure
Test Pressure
Working Pressure Test Pressure
























(inches) (psi)
(psi)

(psi)
(psi)
























________ ___________
Low/High: ________ _________
Low/High: _________
























25. Coiled Tubing BOP:

26. Snubbing Unit BOP:

27. Wireline Lubricator:
























Working Pressure BOP Test Pressure

Working Pressure


Test Pressure
Working Pressure Test Pressure























(psi) (psi)

(psi)


(psi)
(psi) (psi)
























____________
Low/High: __________

____________
Low/High: _________
Low/High: _________ ________























28. CONTACT NAME: 29. CONTACT TELEPHONE NO.: 30. CONTACT E-MAIL ADDRESS:






















31. AUTHORIZING OFFICIAL (Type or print name) 32. TITLE






















33. AUTHORIZING SIGNATURE 34. DATE





























































THIS SPACE FOR MMS USE ONLY






















APPROVED BY: TITLE DATE





























































BOEMRE Form MMS-124 (November 2008 - Supersedes all previous versions of form MMS-124 which may not be used.) Page 1 of 2
































































Sheet 2: MMS-124 pg 2

Application for Permit to Modify (APM) Information Sheet




35) Question Information

Questions

Response
Remarks

a) Is H2S present in the well? If yes, then comment on the inclusion of a Contingency Plan for this operation. YES



NO



N/A












b) Is this proposed operation the only lease holding activity for the subject lease? If yes, then comment. YES



NO



N/A












c) Will all wells in the well bay and related production equipment be shut-in when moving on to or off of an offshore platform, or from well to well on the platform? If not, please explain. YES



NO



N/A

















d) If sands are to be commingled for this completion, has aproval been obtained? YES



NO



N/A












e) Will the completed interval be within 500 feet of a block line? If yes, then comment. YES



NO



N/A












f) For permanent abandonment, will casings be cut 15 feet below the mudline? If no, then comment. YES



NO



N/A












PAPERWORK REDUCTION ACT OF 1995 (PRA) STATEMENT: The PRA (44 U.S.C. 3501 et. seq.) requires us to inform you that we collect this information to obtain knowledge of equipment and procedures to be used in drilling operations. BOEMRE uses the information to evaluate and approve or disapprove the adequacy of the equipment and/or procedures to safely perform the proposed drilling operation. Responses are mandatory (43 U.S.C. 1334). Proprietary data are covered under 30 CFR 250.197. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB Control Number. Public reporting burden for this form, MMS-124, is estimated to average between 1-3 hours per response, depending on whether it is a paper submittal or electronic submittal. This includes the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to the Information Collection Clearance Officer, Mail Stop 5438, BOEMRE, 1849 C Street, NW, Washington, DC 20240.
BOEMRE Form MMS-124 (November 2008 - Supersedes all previous versions of form MMS-124 which may not be used.) Page 2 of 2
































































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