Form 3260-5 Monthly Report of Geothermal Operations

Print
Form 3260-5

UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT

(December 2016)

Reset

FORM APPROVED
OMB NO. 1004-0132
Expires: December 31, 2016

MONTHLY REPORT OF GEOTHERMAL OPERATIONS
3. Lease Serial No.
The Bureau of Land Management (BLM) requires this form or other BLM approval forms
(computerized, company, State, etc.) to be prepared for each month beginning with the month in
which drilling is initiated and filed in duplicate with the BLM, on or before the last day of the month
following unless exception is granted by the BLM.

4. Surface Manager:

The following is a complete and accurate report of all operations and production for the Month
of _______________________, 20______ .
Signed: ____________________________

BLM

FS

Other

5. Unit Agreement Name

Title: _________________________ Date: _______________

6. Field or Area

1. Name of Lessee/Operator

7. County

2. Address of Lessee/Operator

8. State
9. INDIVIDUAL WELL PRODUCTION

TWSP, RGE
SEC., B&M

(Continued on page 2)

WELL
NUMBER

TYPE
(STATUS)

DAYS
PROD.
OR INJ.

MONTHLY PRODUCTION OR INJECTION
TOTAL
(lb)

STEAM
(lb)

WATER
(lb)

PRODUCTION OR INJECTION RATE
TOTAL
(lb)

STEAM
(lb)

WATER
(lb)

AVERAGE
TEMPERATURE
IN
OUT
°F
°F

PRESSURE
psi

TWSP, RGE, SEC.,
B&M

10. OPERATIONS CONDUCTED DURING MONTH: Describe Drilling, Remedial Drilling, Redrilling, Stimulation, Testing and other Well Work Performed.
WELL NUMBER

OPERATIONS CONDUCTED

MONTH END STATUS

Remarks: (use additional pages if needed)

GENERAL INSTRUCTIONS
This form is designed for submitting a complete and accurate account of monthly activity and performance of geothermal wells and production facilities on Federal leases. The report must include
wells on the lease that have not been abandoned.
SPECIFIC INSTRUCTIONS
Item 10: In reporting current operations, particular attention should be directed to 43 CFR
Item 9: Group wells together that are producing or
injecting into the same reservoir or zone, and
distinguish reservoirs or zones by name such as uppe r, lower, formation name, etc. Within each zone, 3264.2-4(e).
list injection wells separately from production wells.
In column 3, show the type of well reported
Remarks: Report in this section any environmental monitoring conducted and the results obtained.
(P= production, I= injection, 1 D=disposal,2, WS= water supply, OB= observation, HE= heat exchange,
1
O= other (specify under remarks) and in parenthesi s the current month end status for each well or
An injection well is used for injection of fluids that are not produced from the formation or
completion (i=injecting, f=flowing, p=pumping, si=shut-in, susp=sus pended, obs=observation, o=other
reservoir.
(specify under remarks)). For heat exchange wells, report production in British thermal units, Btu, and 2 A disposal well is used to inject fluids into the same formation or reservoir from which they are
production rate in Btu/hr. Production or injection rate is the total amount of mass flow divided by the total
produced.

number of active well hours.

Title 18 U.S.C. Section 1001, makes 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 jurisdiction.
(Continued on page 3)

(Form 3260-5, page 2)

NOTICES
The Privacy Act (5 U.S.C. 552a) and 43 CFR 2.48(d) require that we provide you with the following information:
AUTHORITY: 30 U.S.C. 1001-1028; 43 CFR Part 3200.

PRINCIPAL PURPOSE: The BLM uses this information to evaluate the technical, safety, and environmental factors involved with geothermal
resources on Federal geothermal leases.
ROUTINE USES: (1) The adjudication of the form. (2) Documentation for public information in support of notations made on land status, records for
the management, disposal, and use of public lands and resources. (3) Transfer to appropriate Federal agencies when concurrence is required prior to
granting a right in public lands or resources. (4) 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: Disclosure of the information is required for compliance with pertinent statutes and regulations.
If all the information is not provided, the BLM may direct you to take corrective action within a specific time period.
The Paperwork Reduction Act (44 U.S.C. 3501-3521) requires that we provide you with the following information:
The BLM uses this information to evaluate the technical, safety, and environmental factors involved with geothermal resources on Federal geothermal
leases.
Response to this request is required to obtain or retain a benefit.
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: The public reporting burden for this form is estimated to average 10 hours per response, including the time for
reviewing instructions, gathering and maintaining data, and completing and reviewing the form. You may send direct comments regarding the burden
estimate or any other aspect of this form to the U.S. Department of the Interior, Bureau of Land Management (1004-0132), Bureau Information
Collection Clearance Officer (WO-630), 1849 C Street, N.W., Washington, D.C. 20240.

(Form 3260-5, page 3)