Form BSEE-0133S OPEN HOLE DATA REPORT (Supplement to the Well Activity R

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

Form 0133s exp. 2020.xlsx

250.428(c)(3); 428(k); ref in A, D, G - Daily Drilling Reports/Pacific & Alaska

OMB: 1014-0018

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U.S. Department of the Interior











OMB Control Number 1014-0018
Bureau of Safety and Environmental














OMB Approval Expires xx/xx/xxxx
Enforcement (BSEE)

















OPEN HOLE DATA REPORT (Supplement to the 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. (12 digits) 2. OPERATOR NAME
3. WELL NAME 4. SIDETRACK NO. 5. BYPASS NO. 6. CONTACT NAME / CONTACT TELEPHONE NUMBER / CONTACT E-MAIL ADDRESS



7. OPEN HOLE TOOLS, MUDLOGS, AND DIRECTIONAL SURVEYS
GEOSCIENTIST NAME/ GEOSCIENTIST TELEPHONE NUMBER / GEOSCIENTIST E-MAIL ADDRESS:


















Check This Box if Well Total Depth has been reached and this is the Last Logging Run.
SERVICE COMPANY DATE OPERATIONS COMPLETED TOOL LOGGING METHOD LOG TOOL CODE http://www.bsee.gov/About-BSEE/Procurement-Business-Opportunities/BSEE-OCS-Operation-Forms/tool_code.aspx INTERVAL DEPTH (MD)
TOP BOTTOM


















































8. IDENTIFY OTHER OPEN HOLE DATA COLLECTED






Check the following Data Items if collected in the Borehole (Report when data is acquired)











Velocity Surveys

Vertical Seismic Profile

Conventional Cores/Rotary Sidewall Cores

Percussion Sidewall Samples




If Samples are collected, what analysis will be performed? (Report at completion of borehole)
PVT Analysis Paleo Analysis
Geochem Analysis

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 crimincal 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-0133S

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