Form 3160-4 Well Completion and Re-completion Report and Log

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Form 3160-4
(March 2012)

UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT

FORM APPROVED

OMB NO. 1004-0137

Expires: October 31, 2014
5. Lease Serial No.

WELL COMPLETION OR RECOMPLETION REPORT AND LOG
la. Type of Well
b. Type of Completion:

Oil Well
New Well

Gas Well
Work Over

Dry
Deepen

Other
Plug Back

Reset

6. If Indian, Allottee or Tribe Name

Diff. Resvr.,

7. Unit or CA Agreement Name and No.

Other: _____________________________________
2. Name of Operator

8. Lease Name and Well No.

3. Address

3a. Phone No. (include area code)

9. API Well No.

4. Location of Well (Report location clearly and in accordance with Federal requirements)*

10. Field and Pool or Exploratory

At surface

11. Sec., T., R., M., on Block and
Survey or Area

At top prod. interval reported below

12. County or Parish

At total depth
14. Date Spudded
18. Total Depth:

15. Date T.D. Reached
MD
TVD

19. Plug Back T.D.:

21. Type Electric & Other Mechanical Logs Run (Submit copy of each)

Hole Size

Size/Grade

24. Tubing Record
Size

Wt. (#/ft.)

Depth Set (MD)

Top (MD)

Bottom (MD)

Packer Depth (MD)

25. Producing Intervals
Formation
A)

Size

Top

Bottom

16. Date Completed
17. Elevations (DF, RKB, RT, GL)*
D&A
Ready to Prod.
20. Depth Bridge Plug Set:
MD
TVD

MD
TVD

23. Casing and Liner Record (Report all strings set in well)

22. Was well cored?
Was DST run?
Directional Survey?

No
No
No

Stage Cementer
Depth

No. of Sks. &
Type of Cement

Slurry Vol.
(BBL)

Depth Set (MD)

Packer Depth (MD)

Size

26.

Perforation Record
Perforated Interval

Size

Yes (Submit analysis)
Yes (Submit report)
Yes (Submit copy)

Cement Top*

Amount Pulled

Depth Set (MD)

Packer Depth (MD)

No. Holes

B)
C)
D)
27. Acid, Fracture, Treatment, Cement Squeeze, etc.
Depth Interval

Amount and Type of Material

28. Production - Interval A
Date First Test Date Hours
Produced
Tested

Test
Oil
Production BBL

Gas
MCF

Water
BBL

Oil Gravity
Corr. API

Gas
Gravity

Choke
Size

24 Hr.
Rate

Oil
BBL

Gas
MCF

Water
BBL

Gas/Oil
Ratio

Well Status

28a. Production - Interval B
Date First Test Date Hours
Produced
Tested

Test
Oil
Production BBL

Gas
MCF

Water
BBL

Oil Gravity
Corr. API

Gas
Gravity

Choke
Size

24 Hr.
Rate

Gas
MCF

Water
BBL

Gas/Oil
Ratio

Well Status

Tbg. Press. Csg.
Flwg.
Press.
SI

Tbg. Press. Csg.
Flwg.
Press.
SI

Oil
BBL

*(See instructions and spaces for additional data on page 2)

13. State

Production Method

Production Method

Perf. Status

28b. Production - Interval C
Date First Test Date Hours
Produced
Tested

Test
Oil
Production BBL

Gas
MCF

Water
BBL

Oil Gravity
Corr. API

Gas
Gravity

Choke
Size

24 Hr.
Rate

Oil
BBL

Gas
MCF

Water
BBL

Gas/Oil
Ratio

Well Status

28c. Production - Interval D
Date First Test Date Hours
Produced
Tested

Test
Oil
Production BBL

Gas
MCF

Water
BBL

Oil Gravity
Corr. API

Gas
Gravity

Choke
Size

24 Hr.
Rate

Gas
MCF

Water
BBL

Gas/Oil
Ratio

Well Status

Tbg. Press. Csg.
Flwg.
Press.
SI

Tbg. Press. Csg.
Flwg.
Press.
SI

Oil
BBL

Production Method

Production Method

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.

Formation

Top

Bottom

Descriptions, Contents, etc.

Top

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

Sundry Notice for plugging and cement verification

Core Analysis

Other:

Directional Survey

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)

INSTRUCTIONS
GENERAL: This form is designed for submitting a complete and correct well completion/recompletion report and log on all types of
wells on Federal and Indian leases to a Federal agency, pursuant to applicable Federal laws and regulations. Any necessary special
instructions concerning the use of this form and the number of copies to be submitted, particularly with regard to local, area, or
regional procedures and practices, either are shown below or will be issued by, or may be obtained from, the local Federal office.
If not filed prior to the time this summary record is submitted, copies of all currently available logs (drillers, geologists, sample and
core analysis, and all types electric), formation and pressure tests, and directional surveys, should be attached hereto, to the extent
required by applicable Federal laws and regulations. All attachments should be listed on this form, see item 33.
ITEM 4: Locations on Federal or Indian land should be described in accordance with Federal requirements. Consult local Federal
office for specific instructions.
ITEM 17: Indicate which reported elevation is used as reference (where not otherwise shown) for depth measurements given in other
spaces on this form and in any attachments.
ITEM 23: Show how reported top(s) of cement were determined, i.e. circulated (CIR), or calculated (CAL), or cement bond log
(CBL), or temperature survey (TS).

NOTICES

The Privacy Act of 1974 and the regulation in 43 CFR 2.48 (d) provide that you be furnished the following information in connection
with information required by this application.
AUTHORITY: 30 U.S.C. 181 et seq., 351 et seq., 25 U.S.C. et seq.; 43 CFR 3160.
PRINCIPAL PURPOSE: The information is to be used to evaluate the actual operations performed in the drilling, completing and
testing of a well on a Federal or Indian lease.
ROUTINE USES: (1) Evaluate the equipment and procedures used during the drilling and completing/recompleting of a well. (2) The
review of geologic zones and formation encountered during drilling. (3) Analyze future applications to drill in light of data obtained
and methods used. (4)(5) Information from the record and/or the record will be transferred to appropriate Federal, State, local or
foreign agencies, when relevant to civil, criminal or regulatory investigations or prosecutions.
EFFECT OF NOT PROVIDING INFORMATION: Filing of this report and disclosure of the information is mandatory once a well
drilled on a Federal or Indian lease is completed/recompleted.
The Paperwork Reduction Act of 1995 requires us to inform you that:
The BLM collects this information to allow evaluation of the technical, safety, and environmental factors involved with drilling and
completing/recompleting wells on Federal and Indian oil and gas leases.
This information will be used to analyze operations and to compare equipment and procedures actually used with those proposed and
approved.
Response to this request is mandatory only if the operator elects to initiate drilling and completing/recompleting operations on an oil
and gas lease.
The BLM would like you to know that you do not have to respond to this or any other Federal agency-sponsored information
collection unless it displays a currently valid OMB control number.
BURDEN HOURS STATEMENT: Public reporting burden for this form is estimated to average 8 hours per response, including
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 U.S. Department of the Interior, Bureau of Land Management
(1004-0137), Bureau Information Collection Clearance Officer (WO-630), 1849 C Street, N.W., Mail Stop 401 LS, Washington, D.C.
20240.

(Form 3160-4, page 3)