## 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 RECOMP LETlON 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

Rotary Tools 15. Total Depth 16. Plug Back T.D. 17. If Multiple Compl. How Many 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 REC ORD
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, pumpi ng - Size and type pump) Well Status (Prod. or Shut-in)

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

Oil - Bbl. Gas - MCF Water - Bbl. Oil Gravity - API - (Corr.) Flow Tubing 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 comp lete to the best of my knowledge and bel ief



### 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 an y newly-drilled or deepened well. It shall be accompanied by one copy of all el ectrical and radio-activity logs ru n on the well and a summary of all special tests conducted, including drill stem tests. All depths reported sha ll 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 Al amo_______________ T. Pe nn. "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__________________ Ba se 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 a nd 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