Form BSEE-0133 WELL ACTIVITY REPORT

30 CFR 250, Subpart D, Oil and Gas Drilling Operations

Form 0133 exp. 2020.xlsx

250.428(c)(3); 428(k); ref in Subparts A, D, G - Weekly Drilling Reports/GOMR

OMB: 1014-0018

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Overview

0133 pg 1
0133 pg 2
0133 pg 3


Sheet 1: 0133 pg 1

U.S. Department of the Interior

OMB control Number 1014-0018
Bureau of Safety and Environmental






Submit ORIGINAL OMB Approval Expires xx/xx/xxxx
Enforcement (BSEE)
WELL ACTIVITY REPORT




BEGINNING DATE:


ENDING DATE:



REPORT IS NOT TO EXCEED 7 DAYS (1 WEEK) IN DURATION



CORRECTION
CHECK IF THIS IS THE LAST WELL ACTIVITY REPORT
GENERAL INFORMATION
1. API WELL NO. (10 digits) 2. OPERATOR NAME



3. WELL NAME

4. SIDETRACK NO.


5. BYPASS NO.

6. CONTACT NAME / CONTACT TELEPHONE NUMBER / CONTACT E-MAIL ADDRESS





7. RIG NAME OR PRIMARY UNIT (e.g., wireline unit, coil tubing unit, etc.) 8. WATER DEPTH (surveyed) (ft) 9. ELEVATION AT KB (Surveyed) (ft)




10. CURRENT WELLBORE INFORMATION
SURFACE BOTTOM
LEASE NO. AREA NAME BLOCK NO. LEASE NO. BLOCK NO.






WELLBORE START DATE TD DATE STATUS END DATE KOP (MD) MD TVD MW PPG LAST BOP TEST DATE LAST BOP TEST PRESSURE










LOW HIGH





11. WELLBORE HISTORICAL INFORMATION
WELLBORE BOTTOM LEASE START DATE TD DATE PA DATE FINAL MD FINAL TVD




























































































BSEE Form BSEE-0133 (Sept./2020 - Supersedes all previous versions of this form which may not be used.) Page 1 of 3

Sheet 2: 0133 pg 2

WELL ACTIVITY REPORT
12. CASING / LINER / TUBING RECORD
TUBULAR TYPE HOLE SIZE (IN) SIZE (IN) WEIGHT (#/ft) GRADE TEST PRESSURE (psi) SHOE TEST (EMW) SETTING DEPTH (MD) CEMENT QUANTITY (cubic ft.)
TOP BOTTOM


























































































13. WELL ACTIVITY SUMMARY
Provide a daily summary of well activities.












14. Open Hole Log Data
BSEE's Technical Data Management Section requires an Open Hole Well Report (Form BSEE-0133S) to accompany this Well Activity Report if any of the below conditions have occurred for this wellbore during this period:

None of the following have occurred:












Any of the above have occurred; if checked then submit Form BSEE-0133S.
15. Significant Well Events
Please check as many events from the list below:


Kick Occurrence
Well Control Equipment Failure


Shallow Water Flow
H2S Encounter


Weather and Oceanographic Conditions
New Technology Failure

General Rig Equipment Failure
Stuck Pipe


Lost Returns
Wellbore Integrity Failure

Station Keeping Failure
Other




















BSEE Form BSEE-0133 (Sept./2020 - Supersedes all previous versions of this form which may not be used.) Page 2 of 3


Sheet 3: 0133 pg 3

WELL ACTIVITY REPORT






















Please provide narrative information with regards to any significant events. Provide attachments, if necessary.
































MMS:



























CERTIFICATION: I certify that the information submitted is complete and accurate to the best of my knowledge. I understand that making a false statement may subject me to criminal penalties under 18 U.S.C. 1001.


Name and Title: ___________________________________________________ Date: __________________________























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. BSEE uses the information to evaluate and approve or disapprove the adequacy of the equipment and/or procedures to safely perform the proposed drilling operations. 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 Forms BSEE-0133 and BSEE-0133S is approximately 1 hour per form per response. 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, Bureau of Safety and Environmental Enforcement, 45600 Woodland Road, Sterling, VA 20166.
























BSEE Form BSEE-0133 (Sept./2020 - Supersedes all previous versions of this form which may not be used.) Page 3 of 3
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