Form BSEE-0123 Application for Permit to Drill

30 CFR 250, Application for Permit to Drill (APD, Revised APD), Supplemental APD Information Sheet, and all supporting Documentation

Form 0123 exp 2020.xlsx

Subparts A, C, D, E, G, H, P - Actual APD and Supplemental APD

OMB: 1014-0025

Document [xlsx]
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Overview

0123 pg 1
0123 pg 2


Sheet 1: 0123 pg 1

U.S. Department of the Interior











Submit original plus THREE copies,






















OMB Control No. 1014-0025
Bureau of Safety and Environmental










with ONE copy marked "Public Information."























OMB Approval Expires 04/30/2020
Enforcement (BSEE)




































Application for Permit to Drill (APD)
1. PROPOSAL TO DRILL














2. BSEE OPERATOR NO.







3. OPERATOR NAME and ADDRESS











NEW WELL


SIDETRACK



BYPASS


DEEPEN











(Submitting office)














































4. WELL NAME (CURRENT)






5. SIDETRACK NO. (CURRENT)







6. BYPASS NO. (CURRENT)














































7. PROPOSED START DATE






8. PLAN CONTROL NO. (NEW WELL ONLY)






















































9. API WELL NO. (CURRENT SIDETRACK / BYPASS) (12 DIGITS)





























































10.
Revision

11. If revision, list changes:






























WELL AT TOTAL DEPTH (PROPOSED) WELL AT SURFACE
12. LEASE NO.

















17. LEASE NO. and FACILITY NAME



















13. AREA NAME












18. AREA NAME



















14. BLOCK NO.

















19. BLOCK NO.



















15. LATITUDE








16. LONGITUDE







20. LATITUDE







21. LONGITUDE









( NAD 83 / NAD 27)






( NAD 83 / NAD 27)





( NAD 83 / NAD 27)





( NAD 83 / NAD 27)









LIST OF SIGNIFICANT MARKERS ANTICIPATED
22. NAME







23. TOP (MD)



24. TOP (TVD)



22. NAME







23. TOP (MD)



24. TOP (TVD)





















































































































25. LIST ALL ATTACHMENTS (Attach complete well prognosis + attachments required by 30 CFR 250.414 or 30 CFR 250.1617(c) and (d) as appropriate.)
















































































































26. CONTACT NAME















27. CONTACT TELEPHONE NO.







28. CONTACT E-MAIL ADDRESS
















































CERTIFICATION: I certify that 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 (signature in # 31. below).

29. AUTHORIZING OFFICIAL (Type or print name)















30. TITLE































































































31. AUTHORIZING SIGNATURE















32. DATE































































































THIS SPACE FOR BSEE USE ONLY
APPROVED:










BY












TITLE












With Attached Conditions




































Without Conditions




























































DATE










API WELL NO. ASSIGNED TO THIS WELL
















































































































BSEE FORM BSEE-0123 (April 2017 - Supersedes all previous versions of this form which may not be used). Page 1 of 2













































































Sheet 2: 0123 pg 2

Application for Permit to Drill (APD) Information Sheet
33) Question Information Sheet

Questions

Response Remarks
A) Will you maintain quantities of mud and mud material (including weight materials and additives) sufficient to raise the entire system mud weight 1/2 ppg or more? YES
NO
N/A








B) If hydrocarbon-based drilling fluids were used, is the drilling rig outfitted for zero discharge and will zero discharge procedures be followed? YES
NO
N/A








C) If drilling the shallow casings strings riserless, will you maintain kill weight mud on the rig and monitor the wellbore with an ROV to ensure that it is not flowing? YES
NO
N/A








D) If requesting a waiver of the conductor casing, have you submitted a log to BSEE District Office that is with in 500 feet of the proposed bottom hole location for the proposed surface casing point? YES
NO
N/A









E) Will the proposed operation be covered by an EPA Discharge Permit? (please provide permit number in remarks for this question) YES
NO
N/A








F) Will all wells in the well bay and related production equipment be shut-in when moving on to or off of an offshore platform, or from well to well on the platform? If not, please explain. YES
NO
N/A









G) Is the calculated daily volume possible from an uncontrolled blowout of this well greater than the daily volume included in the worst case discharge scenario in the approved oil spill response plan? YES
NO
N/A

H) Has the drilling rig been approved for the use of digital BOP testing? If yes, which version? YES


NO


N/A












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 operation. 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. The burden to fill out Forms BSEE-0123 + BSEE-0123S is estimated at 1 hour per response. This burden represents only the filling out of the forms, the burden for the attachments required range from 30 minutes to 2,800 hours depending on the region and the requirement. 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-0123 (April 2017 - Supersedes all previous versions of this form which may not be used). Page 2 of 2

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