# STATE OF UTAH DEPARTMENT OF NATURAL RESOURCES 

# DIVISION OF OIL, GAS AND MINING AMENDED REPORT FORM 8 (highlight changes) 5. LEASE DESIGNATION AND SERIAL NUMBER: 

# WELL COMPLETION OR RECOMPLETION REPORT AND LOG 6. IF INDIAN, ALLOTTEE OR TRIBE NAME 1a. TYPE OF WELL: OIL WELL GAS WELL DRY OTHER 7. UNIT or CA AGREEMENT NAME b. TYPE OF WORK: 8. WELL NAME and NUMBER:

NEW WELL HORIZ. LATS. DEEPEN REENTRY DIFF. RESVR. OTHER 2. NAME OF OPERATOR: 9. API NUMBER: 3. ADDRESS OF OPERATOR: CITY STATE ZIP PHONE NUMBER: 10 FIELD AND POOL, OR WILDCAT 4. LOCATION OF WELL (FOOTAGES) AT SURFACE: 11. QTR/QTR, SECTION, TOWNSHIP, RANGE, MERIDIAN:
AT TOP PRODUCING INTERVAL REPORTED BELOW: AT TOTAL DEPTH: 12. COUNTY 13. STATE 

## UTAH 14. DATE SPUDDED: 15. DATE T.D. REACHED: 16. DATE COMPLETED: ABANDONED READY TO PRODUCE 17. ELEVATIONS (DF, RKB, RT, GL): 18. TOTAL DEPTH: MD TVD 19. PLUG BACK T.D.: MD TVD 20. IF MULTIPLE COMPLETIONS, HOW MANY? 

### * 21. DEPTH BRIDGE PLUG SET: MD TVD 22. TYPE ELECTRIC AND OTHER MECHANICAL LOGS RUN (Submit copy of each) 23. WAS WELL CORED? NO YES (Submit analysis) WAS DST RUN? NO YES (Submit report) DIRECTIONAL SURVEY? NO YES (Submit copy) 24. CASING AND LINER RECORD (Report all strings set in well) HOLE SIZE SIZE/GRADE WEIGHT (#/ft.) TOP (MD) BOTTOM (MD) STAGE CEMENTER DEPTH CEMENT TYPE & NO. OF SACKS SLURRY VOLUME (BBL) CEMENT TOP 

### ** AMOUNT PULLED

25. TUBING RECORD SIZE DEPTH SET (MD) PACKER SET (MD) SIZE DEPTH SET (MD) PACKER SET (MD) SIZE DEPTH SET (MD) PACKER SET (MD)
26. PRODUCING INTERVALS 27. PERFORATION RECORD FORMATION NAME TOP (MD) BOTTOM (MD) TOP (TVD) BOTTOM (TVD) INTERVAL (Top/Bot - MD) SIZE NO. HOLES PERFORATION STATUS (A) Open Squeezed (B) Open Squeezed (C) Open Squeezed (D) Open Squeezed 28. ACID, FRACTURE, TREATMENT, CEMENT SQUEEZE, ETC. WAS WELL HYDRAULICALLY FRACTURED? YES NO IF YES -- DATE FRACTURED:

____________________________________ DEPTH INTERVAL AMOUNT AND TYPE OF MATERIAL

29. ENCLOSED ATTACHMENTS: ELECTRICAL/MECHANICAL LOGS GEOLOGIC REPORT DST REPORT DIRECTIONAL SURVEY SUNDRY NOTICE FOR PLUGGING AND CE MENT VERIFICATION CORE ANALYSIS OTHER: 30. WELL STATUS:

(5/2013) 

## (CONTINUED ON BACK)31. INITIAL PRODUCTION INTERVAL A (As shown in item #26) DATE FIRST PRODUCED: TEST DATE: HOURS TESTED: TEST PRODUCTION RATES: 

### ! OIL – BBL: GAS – MCF: WATER – BBL: PROD. METHOD: CHOKE SIZE: TBG. PRESS. CSG. PRESS. API GRAVITY BTU – GAS GAS/OIL RATIO 24 HR PRODUCTION RATES: 

### ! OIL – BBL: GAS – MCF: WATER – BBL: INTERVAL STATUS: INTERVAL B (As shown in item #26) DATE FIRST PRODUCED: TEST DATE: HOURS TESTED: TEST PRODUCTION RATES: 

### ! OIL – BBL: GAS – MCF: WATER – BBL: PROD. METHOD: CHOKE SIZE: TBG. PRESS. CSG. PRESS. API GRAVITY BTU – GAS GAS/OIL RATIO 24 HR PRODUCTION RATES: 

### ! OIL – BBL: GAS – MCF: WATER – BBL: INTERVAL STATUS: INTERVAL C (As shown in item #26) DATE FIRST PRODUCED: TEST DATE: HOURS TESTED: TEST PRODUCTION RATES: 

### ! OIL – BBL: GAS – MCF: WATER – BBL: PROD. METHOD: CHOKE SIZE: TBG. PRESS. CSG. PRESS. API GRAVITY BTU – GAS GAS/OIL RATIO 24 HR PRODUCTION RATES: 

### ! OIL – BBL: GAS – MCF: WATER – BBL: INTERVAL STATUS: INTERVAL D (As shown in item #26) DATE FIRST PRODUCED: TEST DATE: HOURS TESTED: TEST PRODUCTION RATES: 

### ! OIL – BBL: GAS – MCF: WATER – BBL: PROD. METHOD: CHOKE SIZE: TBG. PRESS. CSG. PRESS. API GRAVITY BTU – GAS GAS/OIL RATIO 24 HR PRODUCTION RATES: 

### ! OIL – BBL: GAS – MCF: WATER – BBL: INTERVAL STATUS: 32. DISPOSITION OF GAS (Sold, Used for Fuel, Vented, Etc.) 33. SUMMARY OF POROUS ZONES (Include Aquifers): Show all important zones of porosity and c ontents thereof: Cored intervals and all drill- stem tests, including depth interval t ested, cushion used, time tool open, flowing and shut-in pressures and recoveries. 34. FORMATION (Log) MARKERS:

Formation Top (MD) Bottom (MD) Descriptions, Contents, etc. Name Top (Measured Depth)

35. ADDITIONAL REMARKS (Include plugging procedure)

36. I hereby certify that the foregoing and attached informati on is complete and correct as determined from all available reco rds. NAME (PLEASE PRINT) TITLE SIGNATURE DATE 

## This report must be submitted within 30 days of 

## ! completing or plugging a new well 

## ! reentering a previously plugged and abandoned well 

## ! drilling horizontal laterals from an existing well bore 

## ! significantly deepening an existing well bor e below the previous bottom-hole depth 

## ! recompleting to a different producing formation 

## ! drilling hydrocarbon exploratory holes, such as core samples and stratigraphic tests * ITEM 20: Show the number of completions if production is measured separately from two or more formations. ** ITEM 24: Cement Top – Show how reported top(s) of cement were determined (circulated (CIR), calculated (CAL), cement bond lo g (CBL), temperature survey (TS)). Send to: Utah Division of Oil, Gas and Mining Phone: 801-538-5340 1594 West North Temple, Suite 1210 Box 145801 Fax: 801-359-3940 Salt Lake City, Utah 84114-5801 (5/2013)