Sacks Cement
Sacks Cement Packer Set

(MD Ft) Type Depth Set (MD Ft) Size (Inch) String
Well Bore TD Drillers Depth

(MD Ft) Completion Type Section 

### W N

Gas-Oil Ratio Water (Bbls) Flowing Casing Pressure (PSI) BISMARCK, ND 58505-0840 SFN 2468 (04-2010)

F L

Disposition of Gas Calculated 24-Hour Rate Flowing Tubing Pressure (PSI) Oil (Bbls) Gas (MCF) Production for Test Water (Bbls) 

### ° Oil (Bbls) Oil Gravity-API (Corr.) Choke Size 

### / 64 Well Status (Producing or Shut-In) Pumping-Size & Type of Pump Date Well Completed (SEE INSTRUCTIONS) Producing Method 

### PRODUCTION Current Producing Open Hole or Perforated Interval(s), This Completion, Top and Bottom, (MD Ft) Name of Zone (If Different from Pool Name) 

### PERFORATION & OPEN HOLE INTERVALS Isolation Method Date Perf'd or Drilled Date Isolated 

### CASING & TUBULARS RECORD (Report all strings set in well) Anchor Set

(MD Ft) Type of Electric and Other Logs Run (See Instructions) Top Set (MD Ft) Hole Size (Inch) Weight (Lbs/Ft) Top of Cement Spud Date Date TD Reached Drilling Contractor and Rig Number KB Elevation (Ft) At Surface F L Qtr-Qtr Township Range Development County Extension Wildcat 

### LOCATION OF WELL City State Zip Code Permit Type Address Pool Operator Telephone Number Field Well Name and Number Gas Well SWD Well Water Supply Well Other: Deepened Well Spacing Unit Description 

## WELL COMPLETION OR RECOMPLETION REPORT - FORM 6 INDUSTRIAL COMMISSION OF NORTH DAKOTA OIL AND GAS DIVISION Well File No. Oil Well Extended Horizontal Leg EOR Well Added Horizontal Leg Recompletion PLEASE READ INSTRUCTIONS BEFORE FILLING OUT FORM. 600 EAST BOULEVARD DEPT 405 PLEASE SUBMIT THE ORIGINAL AND ONE COPY. Designate Type of Completion
Graded Elevation (Ft) Well Bore Top of Casing Window (MD Ft) Top Bottom Open Hole/Perforated

Interval (MD,Ft) Kick-off Point (MD Ft) Well Bore

Date of Test Gas (MCF) Hours TestedCL ppm Drill Pipe Recovery Sample Chamber Recovery Test Date Formation Top (Ft) Bottom (Ft) CL ppm Formation Top (Ft) Bottom (Ft) BH Temp (oF) Sample Chamber Recovery

Sample Chamber Recovery Drill Pipe Recovery Drill Pipe Recovery Sample Chamber Recovery Drill Pipe Recovery Sample Chamber Recovery Shut-in 1 (PSIG) Shut-in 2 (PSIG) H2S ppm Shut-in 1 (PSIG) Shut-in 2 (PSIG)
H2S ppm Bottom (Ft) BH Temp (oF) CL ppm BH Temp (oF) Drill Pipe Recovery H2S ppm Shut-in 1 (PSIG) Shut-in 2 (PSIG) Test Date Test Date Formation Top (Ft) H2S ppm Shut-in 1 (PSIG) Shut-in 2 (PSIG) BH Temp (oF) CL ppm Test Date Formation Top (Ft) Bottom (Ft) 

## Drill Stem Test Test Date Top (Ft) Formation Bottom (Ft) Formation Bottom (Ft) Top (Ft) Bottom (Ft) Formation Top (Ft) 

## CORES CUT Type of Plug Sacks Cement Top (Ft) Bottom (Ft) Formation MD (Ft) TVD (Ft) Well Bore Page 2 SFN 2468 (04-2010) 

## GEOLOGICAL MARKERS PLUG BACK INFORMATION

Shut-in 2 (PSIG) BH Temp (oF) CL ppm H2S ppm Shut-in 1 (PSIG)I hereby swear or affirm that the information provided is true, complete and correct as determined from all available records. Lbs Proppant Maximum Treatment Pressure (PSI) Maximum Treatment Rate (BBLS/Min)

Date Email Address Type Treatment Acid % Lbs Proppant Type Treatment Acid % Lbs Proppant Maximum Treatment Pressure (PSI) Maximum Treatment Pressure (PSI)

Maximum Treatment Pressure (PSI) Type Treatment Acid % Lbs Proppant

Date Stimulated Stimulated Formation Date Stimulated Stimulated Formation Maximum Treatment Rate (BBLS/Min) Top (Ft) Bottom (Ft) Volume Volume Units Volume Volume Units Stimulation Stages Volume Stimulation Stages Volume Units Page 3 SFN 2468 (04-2010) 

### Well Specific Stimulations Top (Ft) Stimulated Formation Volume Units Volume Stimulation Stages

Details Type Treatment Acid % Maximum Treatment Rate (BBLS/Min) Volume Volume Units Stimulation Stages Maximum Treatment Rate (BBLS/Min)

Signature Details Top (Ft) Bottom (Ft) Stimulation Stages

Printed Name Title Details Bottom (Ft)

Top (Ft) Bottom (Ft) Date Stimulated

Details Acid % Type Treatment Maximum Treatment Pressure (PSI) Lbs Proppant



### ADDITIONAL INFORMATION AND/OR LIST OF ATTACHMENTS Date Stimulated Stimulated Formation Maximum Treatment Rate (BBLS/Min) Top (Ft) Bottom (Ft) Details Date Stimulated Stimulated Formation

### 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. The operator shall file with the Commission two copies of all logs run. Logs shall be submitted as one digital TIFF (tagged image file format) copy and one digital LAS (log ASCII) formatted copy, or a format approved by the Director. In addition, operators shall file two copies of drill stem test reports and charts, formation water analyses, core analyses, geologic reports, and noninterpretive lithologic logs or sample descriptions if compiled by the operator. A certified copy of any directional survey run shall be filed directly with the Commission by the survey contractor. In the "Production" section, list all the current producing open hole or perforated intervals associated with the production rates reported. Oil, gas, and water rates and recoveries from perforations or laterals tested but not included in the completion should be included in the "Additional Information" portion of the report or included as an attachment.
Stimulations for laterals can be listed as a total for each lateral. WELL COMPLETION OR RECOMPLETION REPORT - FORM 6 SFN 2468 This report shall be filed by the operator with the Commission immediately after the completion of a well in an unspaced pool or reservoir. Please refer to Section 43-02-03-31 of the North Dakota Administrative Code (NDAC). In the "Perforation & Open Hole Intervals" table, each borehole should be identified in the "Well Bore" column (vertical, sidetrack 1, lateral 1, etc.). On horizontal or directional wells, the following information shall be entered in the table if applicable: pilot hole total depth, kick-off point, casing windows, original lateral total depth, and all sidetracked interval starting and ending footages.

The original and one copy of this report shall be filed with the Industrial Commission of North Dakota, Oil and Gas Division, 600 East Boulevard, Dept. 405, Bismarck, ND 58505-0840. This report shall be filed by the operator with the Commission within thirty (30) days after the completion of a well, or recompletion of a well in a different pool. Please refer to Section 43-02-03-31 NDAC. The well file number, operator, well name and number, field, pool, permit type, well location(s), and any other pertinent data shall coincide with the official records on file with the Commission. If it does not, an explanation shall be given. If a parasite string was used in the drilling of a well, the size, depth set, cement volume used to plug, and the date plugged shall be included. This information may be included in the "Additional Information" portion of the report or included as an attachment. In The “Date Well Completed” portion of the form please report the appropriate date as follows: - An oil well shall be considered completed when the first oil is produced through wellhead equipment into tanks from the ultimate producing interval after casing has been run. - A gas well shall be considered complete when the well is capable of producing gas through wellhead equipment from the ultimate producing zone after casing has been run. - For EOR or SWD wells, please report the date the well is capable of injection through tubing and packer into the permitted injection zone. Also, please report the packer type and depth and the tubing size, depth, and type. The packer and tubing type may be included in the "Additional Information" portion of the report. The top of the Dakota Formation shall be included in the "Geological Markers."