Sacks 

Cement

Sacks 

Cement

Packer Set 

Type (MD Ft)

Depth Set

Size (Inch) (MD Ft)

String

Well Bore TD

Drillers Depth

 (MD Ft)

Completion

Type

Section

N W

Flowing Casing Pressure (PSI) Water (Bbls) Gas-Oil Ratio

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)

°

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

/64

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

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

Wildcat Extension

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 EOR Well Added Horizontal Leg Recompletion Extended Horizontal Leg

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 Hours Tested Gas (MCF)
CL ppm

Drill Pipe Recovery

Sample Chamber Recovery

Test Date Formation Top (Ft) Bottom (Ft)

Formation Top (Ft) Bottom (Ft) BH Temp (oF) CL ppm

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)

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

Drill Stem Test

Test Date Formation Top (Ft) Bottom (Ft)

Top (Ft) Bottom (Ft) Formation Top (Ft) Bottom (Ft) Formation

CORES CUT

Formation MD (Ft) TVD (Ft) Well Bore Type of Plug Top (Ft) Bottom (Ft) Sacks Cement

Page 2

SFN 2468 (04-2010)

GEOLOGICAL MARKERS PLUG BACK INFORMATION

BH Temp (oF) CL ppm H2S ppm Shut-in 1 (PSIG) Shut-in 2 (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)

Email Address Date

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

Stimulated Formation Top (Ft) Stimulation Stages Volume Volume Units

Details

Type Treatment Acid %

Maximum Treatment Rate (BBLS/Min)

Stimulation Stages Volume Volume Units

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

Type Treatment Maximum Treatment Pressure (PSI) Acid % 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."