Original Recompletion of New Zone Workover of Dry Type Well: Oil Dry SWD/ Gas Other

 Commingle, Well Conversion Existing Zone Hole Gas EOR Condensate

Field Address

Pool Completed in City

No. State Zip

Sec. Rge. Phone

Fax

Work Completed E-Mail

KB GL DF Total Depth Drilled

Electric Log Run: Filed:

Conductor: (Size & Wt.) set at ft. w/ sks.

set at ft. w/ sks.

set at ft. w/ sks.

set at ft. w/ sks.

set at ft. ft.

Perforated/Open Hole Intervals

Is this a commingle of existing zones?

Plugged Back TD Electric Log Run: Filed:

Plugged Back BHL

Liner: (Size & Wt.) From ft. to ft. w/ sks.

Tubing: (Size & Wt.) set at ft. Packer Depth ft.

Perforated/Open Hole Intervals

w/ gals.

w/ w/

Describe Work:

Is this well the only completion in the common source of supply within the unit? 

If no, have additional completion(s) been authorized by General Rule or appoved by Commission Order? 

Disposition of gas from this well: 

Test Length hrs. Production Method:

Tubing Pressure Casing Pressure BHP

Net Oil in 24 Hours: bbls. SW bbls. Gravity Oil

MCF bbls.

 

API No. 03-

Well Name

Permit No. 

Elevation:

(Date)

SECTION B - FILL OUT FOR NEW WELLS

Bottom hole location

Twp.

SECTION D - WELL TREATMENT (See instructions on back)

Commingle approved by General Rule or Commission Order?

Tubing: (Size & Wt.) Packer Depth

Choke/Orifice Size:

Date of Test:

SECTION F - PRODUCER'S PRODUCTION TEST (See instructions on back)

Estimated Daily Gas Production Rate (24 Hrs.): Est. Daily Gas Well SW:

CERTIFICATE

I declare under the penalties of perjury that this report has been examined by me and to the best of my knowledge is true, correct, and complete.

Signature

Typed or Clearly Printed Name

Revised 04/09

FORM 3

PRODUCER'S WELL COMPLETION AND RECOMPLETION REPORT

 Brine

SECTION A - WELL DESCRIPTION - MUST BE COMPLETED

Completion

Producer's Name

County

(Date)

Work Commenced

PBTD

Drilling Unit Description:

Surface: (Size & Wt.)

Production: (Size & Wt.) 

Intermediate: (Size & Wt.)

SECTION C - FILL OUT FOR RECOMPLETION OF NEW ZONE, WORKOVER, COMMINGLE OR CONVERSION

Fractured: Interval

Acidized: Interval

SECTION E - PRODUCTION INFORMATION (See instructions on back)

lbs. of sand bbls. of fluid type of fluid

GOR

WHSIP

Surface hole location

ARKANSAS

OIL AND GAS

COMMISSION

Yes No Yes No

Yes No

Yes No

Yes No

 Vented (approval required) Lease Fuel Sold

Flowing Gas Lift Rod Pump Cent. Pump

Yes No

Yes No

Yes No Yes No

Submit Form To Appropriate District Office:

Fort Smith Regional Office

3309 Phoenix Avenue

Fort Smith, Arkansas 72903

El Dorado Regional Office

P. O. Box 11510

El Dorado, Arkansas 71731 

Yes No
INSTRUCTIONS FOR FILING FORM 3

1.

4.

5. For workovers of previously completed zones in existing wells, complete Sections A, C, D and F.

For conversion of a producing well into use as a SWD/EOR well, check the "Recompletion of New Zone, Commingle or

Well Conversion" box and "SWD/EOR" box at top of Form and complete Sections A, C and D.

For commingle of zones in an existing well, check the "Recompletion of New Zone or Commingle" box and "Type of

Well" box at top of Form and complete Section A and answer the commingle questions in Section C.

For completion of a new zone in an existing well, check the "Recompletion of New Zone or Commingle" box and "Type

of Well" box at top of Form and complete Sections A, C, D, E, and F.

3.

Form 3 is required to be submitted in accordance with General Rule B-5, or wiithin 30 days of the plugging of a dry hole. 

Please check the appropriate office where form is to be sent.

7.

6.

For a dry hole, check "Dry Hole" box and "Type of Well" box at top of Form and complete Sections A and B.

For newly drilled wells check the "Original Completion" box and "Type of Well" boxes at top of Form and complete

Sections A, B, D, E and F.

2.