Form C-105

Revised June 10, 2003 

WELL API NO. 

5. Indicate Type of Lease 

 STATE FEE 

Submit To Appropriate District Office 

State Lease - 6 copies 

Fee Lease - 5 copies 

District I

1625 N. French Dr., Hobbs, NM 88240 

District II

1301 W. Grand Avenue, Artesia, NM 88210 

District III

1000 Rio Brazos Rd., Aztec, NM 87410 

District IV

1220 S. St. Francis Dr., Santa Fe, NM 87505

State of New Mexico 

Energy, Minerals and Natural Resources 

Oil Conservation Division 

1220 South St. Francis Dr. 

Santa Fe, NM 87505 State Oil & Gas Lease No. 

WELL COMPLETION OR RECOMPLETlON REPORT AND LOG 

1a. Type of Well: 

 OIL WELL GAS WELL DRY OTHER______________________________ 

 b. Type of Completion: 

 NEW WORK DEEPEN PLUG DIFF. 

 WELL OVER BACK RESVR. OTHER 

7. Lease Name or Unit Agreement Name 

2. Name of Operator 8. Well No. 

3. Address of Operator 9. Pool name or Wildcat 

4. Well Location 

 Unit Letter __________:___________ Feet From The________________________ Line and____________________ Feet From The _______________________Line 

 Section Township Range NMPM County 

10. Date Spudded 11. Date T.D. Reached 12. Date Compl. (Ready to Prod.) 13. Elevations (DF& RKB, RT, GR, etc.) 14. Elev. Casinghead 

15. Total Depth 16. Plug Back T.D. 17. If Multiple Compl. How Many Rotary Tools 

 Zones? 

18. Intervals 

Drilled By 

Cable Tools 

19. Producing Interval(s), of this completion - Top, Bottom, Name 20. Was Directional Survey Made 

21. Type Electric and Other Logs Run 22. Was Well Cored 

23. CASING RECORD (Report all strings set in well) 

CASING SIZE WEIGHT LB./FT. DEPTH SET HOLE SIZE CEMENTING RECORD AMOUNT PULLED

 

24. LINER RECORD 25. TUBING RECORD 

SIZE TOP BOTTOM SACKS CEMENT SCREEN SIZE DEPTH SET PACKER SET 

 

27. ACID, SHOT, FRACTURE, CEMENT, SQUEEZE, ETC.

DEPTH INTERVAL AMOUNT AND KIND MATERIAL USED 

 

 

26. Perforation record (interval, size, and number) 

 

28 PRODUCTION

Date First Production Production Method (Flowing, gas lift, pumping - Size and type pump) Well Status (Prod. or Shut-in)

Date of Test Hours Tested Choke Size Prod'n For Oil - Bbl Gas - MCF Water - Bbl. Gas - Oil Ratio 

Test Period 

Flow Tubing Oil - Bbl. Gas - MCF Water - Bbl. Oil Gravity - API - (Corr.)

Press. 

Casing Pressure Calculated 24- 

Hour Rate 

29. Disposition of Gas (Sold, used for fuel, vented, etc.) Test Witnessed By 

30. List Attachments 

31 .I hereby certify that the information shown on both sides of this form as true and complete to the best of my knowledge and belief

 Printed 

Signature Name Title Date 

E-mail Address 
INSTRUCTIONS 

This form is to be filed with the appropriate District Office of the Division not later than 20 days after the completion of any newly-drilled or 

deepened well. It shall be accompanied by one copy of all electrical and radio-activity logs run on the well and a summary of all special tests 

conducted, including drill stem tests. All depths reported shall be measured depths. In the case of directionally drilled wells, true vertical depths 

shall also be reported. For multiple completions, items 25 through 29 shall be reported for each zone. The form is to be filed in quintuplicate 

except on state land, where six copies are required. See Rule 1105. 

INDICATE FORMATION TOPS IN CONFORMANCE WITH GEOGRAPHICAL SECTION OF STATE 

Southeastern New Mexico Northwestern New Mexico 

T. Anhy___________________ T. Canyon__________________ T. Ojo Alamo_______________ T. Penn. "B"________________ 

T. Salt____________________ T. Strawn___________________ T. Kirtland-Fruitland__________ T. Penn. "C"______________

B. Salt____________________ T. Atoka___________________ T. Pictured Cliffs_____________ T. Penn. "D"________________ 

T. Yates___________________ T. Miss____________________ T. Cliff House_______________ T. Leadville________________ 

T. 7 Rivers_________________ T. Devonian________________ T. Menefee_________________ T. Madison_________________ 

T. Queen__________________ T. Silurian__________________ T. Point Lookout_____________ T. Elbert___________________ 

T. Grayburg________________ T. Montoya_________________ T. Mancos__________________ T. McCracken______________ 

T. San Andres______________ T. Simpson_________________ T. Gallup___________________ T. Ignacio Otzte_____________ 

T. Glorieta_________________ T. McKee__________________ Base Greenhorn______________ T. Granite__________________ 

T. Paddock________________ T. Ellenburger_______________ T. Dakota__________________ T_________________________ 

T. Blinebry________________ T. Gr. Wash_________________ T. Morrison_________________ T.________________________ 

T.Tubb____________________ T. Delaware Sand____________ T.Todilto___________________ T_________________________ 

T. Drinkard________________ T. Bone Springs_____________ T. Entrada__________________ T.________________________ 

T. Abo____________________ T._________________________ T. Wingate_________________ T.________________________ 

T. Wolfcamp_______________ T._________________________ T. Chinle___________________ T.________________________ 

T. Penn___________________ T._________________________ T. Permian__________________ T.________________________ 

T. Cisco (Bough C)__________ T._________________________ T. Penn "A"_________________ T.________________________ 

OIL OR GAS 

SANDS OR ZONES 

No. 1, from............................to............................... No. 3, from...........................to............................... 

No. 2, from...........................to............................... No. 4, from...........................to............................... 

IMPORTANT WATER SANDS 

Include data on rate of water inflow and elevation to which water rose in hole. 

No. 1, from........................................to.............................................feet.......................................... 

No. 2, from........................................to.............................................feet.......................................... 

No. 3, from........................................to.............................................feet.......................................... 

LITHOLOGY RECORD (Attach additional sheet if necessary)

From To Thickness 

In Feet Lithology From To Thickness 

In Feet Lithology