Form 208 Form 208 Well Completion or Re-completion Report and Log

Form 208 (rev) (March 2015)

FORM APPROVED OMB No. [] Expires XX/XX/XXXX

UNITED STATES DEPARTMENT OF THE INTERIOR OSAGE AGENCY WELL COMPLETION OR RECOMPLETION REPORT AND LOG

5. Lease Serial No.

6. If Indian, Allotee or Tribe Name

1a. Type of Well: □ Oil Well □ Gas Well □ Dry □ Other 1b. Type of Completion: □ New Well □ Work Over □ Deepen □ Plug Back □ Diff. Reserv., □ Other:

7. If Unit or CA Agreement, Name and No.

8. Lease Name and Well No.

2. Name of Operator

9. API Well No.

3 Address

3a Phone No. (include area code)

10. Field and Pool, or Exploratory

4. Location of Well (Report location clearly*) At surface At top prod. Interval reported below At total depth

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

12. Country or Parish

13. State

14. Date Spudded

15. Date T.D. Reached

16. Date Completed □ D&A □ Ready to Prod.

17. Elevations (DF, RKB, RT, GL)*

18. Total Depth: MD TVD

19. Plug Back T.D.: MD TVD

20. Depth Bridge Plug Set MD TVD

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

22. What was cored? □ No □ Yes (Submit Analysis) Was DTS run? □ No □ Yes (Submit Report) Directional Survey? □ No □ Yes (Submit Copy)

23. Casting and Linear Record (Report all strings in well)

Hole Size

Size/Grade

Wt.(#/ft)

Top (MD)

Bottom (MD)

Stage Cementer Depth

No. of Sks. & Type of Cement

Slurry Vol. (BBL)

Cement Top*

Amount Pulled

24. Tubing Record

Size

Depth Set (MD)

Packer Depth (MD)

Size

Depth Set (MD)

Packer Depth (MD)

Size

Depth Set (MD)

Packer Depth (MD)

25. Producing Intervals

26. Perforation Record

Formation

Top

Bottom

Perforated Interval

Size

No. Holes

Perf. Status

A)

B)

C)

D)

27. Acid, Fracture, Treatment, Cement Squeeze, etc.

Depth Interval

Amount and Type of Material

28. Production – Interval A

Date First Produced

Test Date

Hours Tested

Test Production

Oil BBL

Gas MCF

Water BBL

Oil Gravity Corr. API

Gas Gravity

Production Method

Choke Size

Tbg. Press. Flwg. SI

Csg. Press.

24 Hr. Rate

Oil BBL

Gas MCF

Water BBL

Gas/Oil Ratio

Well Status

28a. Production – Interval B

Date First Produced

Test Date

Hours Tested

Test Production

Oil BBL

Gas MCF

Water BBL

Oil Gravity Corr. API

Gas Gravity

Production Method

Choke Size

Tbg. Press. Flwg. SI

Csg. Press.

24 Hr. Rate

Oil BBL

Gas MCF

Water BBL

Gas/Oil Ratio

Well Status

28b. Production – Interval C

Date First Produced

Test Date

Hours Tested

Test Production

Oil BBL

Gas MCF

Water BBL

Oil Gravity Corr. API

Gas Gravity

Production Method

Choke Size

Tbg. Press. Flwg. SI

Csg. Press.

24 Hr. Rate

Oil BBL

Gas MCF

Water BBL

Gas/Oil Ratio

Well Status

28c. Production – Interval D

Date First Produced

Test Date

Hours Tested

Test Production

Oil BBL

Gas MCF

Water BBL

Oil Gravity Corr. API

Gas Gravity

Production Method

Choke Size

Tbg. Press. Flwg. SI

Csg. Press.

24 Hr. Rate

Oil BBL

Gas MCF

Water BBL

Gas/Oil Ratio

Well Status

29. Disposition of Gas (Solid, used for fuel, vented, etc.)

30. Summary of Porous Zones (Include Aquifers): 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.

31. Formation (Log) Markers

Formation

Top

Bottom

Descriptions, Contents, etc.

Name

Top

Meas. Depth

32. Additional remarks (including 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) □ Geological Report □ DST Report □ Directional Survey □ Notice for plugging and cement verification □ Core Analysis □ Other:

34. I hereby certify that the foregoing and attached information is completed 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.

INSTRUCTIONS

GENERAL: This form is designed for submitting a complete and correct well completion/recompletion report and log on all types of wells on 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 local Federal offices.

ITEM 4: Locations on Indian land should be described in accordance with Federal requirements. Consult local Federal offices for specific instructions.

ITEM 17: Indicate which reported elevation is used as reference (where not otherwise shown) for depth measurements give in other spaced 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 regulation in 25 C.F.R. 226.34(b) provide that you be furnished the following information in connection with information required by this application.

AUTHORITY: 25 C.F.R. Part 226, 200 DM 1, 209 DM 8, 230 DM 1, 3 IAM 4.1 and Muscogee Area Addendum 9901 to 3 IAM 4 PRINCIPAL PURPOSES: The information will be used to evaluate the actual operations performed in the drilling, completing and testing of a well on a Federal or Indian lease.

ROUTINE USE: (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) Information from the record and/or the record will be transferred to appropriate Federal, State, and local or foreign agencies, when relevant to civil, criminal or regulatory investigations or prosecution, in connection with congressional inquiries and for regulatory responsibilities.

EFFECT OF NOT PROVIDING INFORMATION: Filing of this application and disclosure of the information is mandatory once a well drilled on a Federal or Indian lease is complete/recompleted.

The Paperwork Reduction Act of 1995 requires us to inform you that:

The BIA/Osage Agency collects this information to allow evaluation of the technical, safety, and environmental factors involved with drilling for oil and/or gas on Federal and Indian oil and gas leases. This information will be used to analyze and approve applications. Response to this request is mandatory only if the operator elects to initiate drilling or reentry operations on an oil and gas lease. The BIA/Osage Agency 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 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: Information Collection Clearance Officer – Indian Affairs, 1849 C Street, N.W., Mail Stop 3642, Washington, DC 20240.