Form 3260-4 Geothermal Well Completion Report

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Form 3260-4
(December 2016)

UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT

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FORM APPROVED
OMB NO. 1004-0132
Expires: December 31, 2016
4. Lease Serial No.

GEOTHERMAL WELL COMPLETION REPORT
The Bureau of Land Management (BLM) requires this form or other BLM-approved forms to be prepared
and filed in duplicate with requisite attachments within 30 days after the completion of permitted operations.
la. Well Type
1b. Type of Completion:
2. Name of Lessee/Operator

Production
Cold
New
Recompleted

Injection
Disposal
Heat Exchange
Other
Workover
Deepened
Drilled & Abandoned

5. Surface Manager:
Other

BLM

Water Supply

Observation

6. Unit Agreement Name

Plugback
Other

Redrill

7. Well No.

FS

8. Permit No.

9. Field or Area
10. Sec., T., R., B. & M.

3. Address of Lessee/Operator

11. County
12. State

18. Location of Well
At surface:
At Top of Production Zone:
At Total Depth:
19. Total Depth
Measured:

13. Spud Date

22. Drilling Media:
List characteristics

14. Completion Date (ready to produce)

True Vertical:

20. Plugback Total Depth
Measured:
21. Elevation:
Estimated
Reference Datum:
GR

15. Directionally Drilled Intervals

True Vertical:

Air

Final
MAT

DF

KB

RT

Water

Mud

Foam

Other

Date T.D. Reached

16. Surveyed Intervals
Casinghead Flange

Other
17. Core Size and Intervals

23. Log Type & Intervals

24. CASING RECORD
Size

Weight

Grade

Depths Set
Top
SHoe

Collars & Threads

Cementing Record
(slurry volume)

Hole Size

25. LINER RECORD
Size

Weight

Size

Weight

Type

Total No.

Grade

Collars & Threads

26. TUBING RECORD
Grade

Top

Bottom

Perforated Intervals

Cementing Record
(slurry volume)

27. Cement Squeeze, Acid, Fracture, etc (detail type, amount, intervals)
Depth Set

Density (No./ft)

Packer Depth
28. PERFORATION RECORD

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

31. Do you consider the well to be commercial?

Suspended
Yes

No

Injection

Disposal

Heat Exchange

Abandoned

Water Supply

Other

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 ____________________________

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 2)

Test Date

Production
Method:

Flowing
Other

34. PRODUCTION
Production During Test

Hours Tested
Total Liquids (lb)

Depth

Surface Pressure
Wellhead:
Separator:

33. WELL TEST
Pumping – include size type, intake depth, etc.

Surface Pressure (psig)

Subsurface Pressure
at ___________feet

Enthalpy (Btu/lb)

Steam (lb)
35. STATIC TEST DATE
Subsurface Pressure (psig)

Water (lb)

Subsurface Temperature (°F)

36. FLOWING TEST DATA
Surface Temperature
Subsurface temperature at
top of perfs.

37. SUMMARY OF POROUS ZONES. Show all important porous zones and contents of each; cored intervals with
recoveries, drill stem or formation tests with depth of interval tested, time open, cushion used, and flowing and shut-in
pressures, temperatures and recoveries.
Formation

(Continued on page 3)

Top

Bottom

Description of Details

Water Analysis
Total Dissolved Solids

pH

Avg. Total Mass Flow Rate Per Hour
Total (lb/hr)
Steam (lb/hr)
Water (lb/hr)
38.

GEOLOGIC MARKERS (TOP)
Name

Measured Depth

True Vertical
Depth

(Form 3260-4, page 2)

GENERAL INSTRUCTIONS
GENERAL: This form is designed for submitting a complete and accurate geothermal well completion report, and must be accompanied
by a detailed chronological history of well operations as well as the final copies of the results of any logs, surveys or tests performed on
the well that have not previously been submitted. The report must be submitted within 30 days after the date of completion of continuous
well activities as determined by the BLM. The completion date usually is the day that the well became producible; generally the date of
initial production test. The BLM may postpone the required report submittal date if adequate justification is presented by the lessee.

SPECIFIC INSTRUCTIONS
Item 18: Show the surface location coordinates from the nearest section corner or tract line. Show production zone and total depth
coordinates from the surface location if the well is directionally drilled.
Item 34: If the well is immediately placed into operation without testing, this section should reflect the first month's production data.
Items 35 & 36: Indicate the depth(s) of subsurface pressure, temperature measurement, and include the reference datum.

NOTICES

The Privacy Act of 1974 and 43 CFR 2.48(d) require that you be furnished 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 this 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 to seek approval of geothermal drilling
operations. If all the information is not provided, geothermal drilling operations might not be approved.
The Paperwork Reduction Act of 1995 requires us to inform you that:
The BLM collects this information to evaluate the technical, safety, and environmental factors involved with geothermal resources on
Federal geothermal leases.
The BLM will use this information to analyze operations and to compare equipment and procedures actually used with proposals that
you applied for.
Response to this request is required to obtain or maintain a benefit.
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 10 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 (1004-0132),
Bureau Information Collection Clearance Officer (WO-630), 1849 C Street, N.W., Washington, D.C. 20240.

(Form 3260-4, page 3)