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i 6w DIVISION OF OIL AND GAS CHECK LIST - RECORDS RECEIVED AND WELL STATUS y Company l./ -`I/Ga Well No. " - Ih 6 e� API No. -' :7 / OLLV I Sec. 5 , T. Z , yC , /y.D B.&M. County S:;_4 Field ffr RECORDS RECEIVED DATE STATUS STATUS Well Summary (Form OG100) -7 Producing - 10il Water Disposal _ History (Form OG103) Idle - OilI Waterflood Core Record (Form OG101) Abandoned - Oil Steamflood Directional Survey Drilling - 4dle Fire Flood _ V Sidewall Samples Abandoned I . - JDry Hole. Air Injection _Other Producing - Gaa _ Gas Injection Date final records received Idle - Gas -.. — CO2 Injection lectric logs: Lij /r;�c ; 'R.,,,' 9 Abandoned - 'Gas _ LPG Injection a v,J Gh' f -:< -.Ff f R":, .3 P-is -F$ Gas-Open to Oil Zone_ Observation ✓ �� / ✓ '✓ -S� �� Gas Storage Waterflood Source_ c ✓ /?_ri 2 3 Z ✓ DATE "E" well Yes ❑ No E I, n L SfG. j?,;n z �j 2' S 1_ Y D a k,� 2. 3 5' ✓ RECOMPLETED C(?t- A- C'✓fir �,n lK "/�✓n 3 ✓ REMARKS ENGINEER'S CHECK LIST CURICAL CHECK LIST 1. Summary, History, & 1. LocatioT change� (F-OGD165) L Core record (dupl.) 2. Elevation chance'_(F-ocD165) 2. Electric Log 3. Form OGD121 1� 3. Operator' s Name 4. Form OGT59 (Final Letter) L 4. Signature ✓ 5. Form OGD150b (Release of Bond) 5. Well Designation 6. Duplica�e logs to archives 6. Location 7. Notice pf Records due(F-OGD170) 7. Elevation 8. EDP (F- GD42A-1, 2) L 8. Notices ✓ 9. "T" Reports 10. Casing Record / L 11. Plugs 12. Surface Inspection _ 13. Production 14. E Well on Prod. , enter EDP r 15. Directional Survey E�`7�"iRk"9Prrr'Id""c.ii� 0 L ✓ G' VlJ� 1` Z� ✓ Sa.,ic Rv+ .'.. Dip 2- L 120, 9 RECORDS NOT APPROVED / ` T 1- - RECORDS APPROVED L _ Reason:_ A/ r " or - n / RELEASE BON;p Date Eligli_ble (Use date last needed records were ?r received.I) MAP AND MA , BOOK /1J+j T— � Gad- ;