API PLEASE TYPE OR USE BLACK INK ONLY

NO.

OTC PROD.

UNIT NO.

ORIGINAL

640 Acres

STRAIGHT HOLE DIRECTIONAL HOLE HORIZONTAL HOLE

SERVICE WELL

If directional or horizontal, see reverse for bottom hole location.

WELL

NO.

FSL OF FWL OF W E

1/4 SEC 1/4 SEC

OPERATOR OTC/OCC

NAME OPERATOR NO.

LOCATE WELL

COMPLETION TYPE CASING & CEMENT (Form 1002C must be attached)

MULTIPLE ZONE

Application Date

SPACING & SPACING

ORDER NUMBER

PERFORATED

INTERVALS

Min Gas Allowable (165:10-17-7) Gas Purchaser/Measurer

OR First Sales Date

Oil Allowable (165:10-13-3)

INITIAL TEST DATE

OIL-BBL/DAY

OIL-GRAVITY ( API)

GAS-MCF/DAY

GAS-OIL RATIO CU FT/BBL

WATER-BBL/DAY

PUMPING OR FLOWING

INITIAL SHUT-IN PRESSURE

CHOKE SIZE

FLOW TUBING PRESSURE

TYPE

 SAX TOP OF CMT

1/4

DATE OF WELL 

COMPLETION

BRAND & TYPE

1st PROD DATE

PLUG @

Longitude 

(if known)

PLUG @

LEASE 

NAME

1/4 1/4 1/4

INCREASED DENSITY 

ORDER NO.

SURFACE COMMINGLED 

Application Date

LOCATION 

EXCEPTION ORDER 

ADDRESS

SINGLE ZONE

Ground Latitude (if known)

CITY

FORMATION

PACKER @ BRAND & TYPE

ZIP

SPUD DATE

OKLAHOMA CORPORATION COMMISSION

 PSI

DRLG FINISHED 

DATE

Oklahoma City, Oklahoma 73152-2000

Post Office Box 52000

Oil & Gas Conservation Division

Rule 165:10-3-25

PHONE NUMBER

EMAIL ADDRESS

NAME (PRINT OR TYPE)

FRACTURE TREATMENT

(Fluids/Prop Amounts)

INITIAL TEST DATA

DEPTH

ACID/VOLUME

PACKER @ TYPE

RGE

STATE

TYPE

TOTAL

PLUG @

RECOMP DATE

TYPE

AMENDED (Reason)

TYPE OF DRILLING OPERATION

COUNTY

ELEVATIO

N Derrick 

SEC TWP

PLUG @

ADDRESS

CLASS: Oil, Gas, Dry, Inj,

A record of the formations drilled through, and pertinent remarks are presented on the reverse. I declare that I have knowledge of the contents of this report and am authorized by my organization

to make this report, which was prepared by me or under my supervision and direction, with the data and facts stated herein to be true, correct, and complete to the best of my knowledge and belief.

SIGNATURE DATE

 Disp, Comm Disp, Svc

 WEIGHT GRADE FEET

CONDUCTOR

LINER

INTERMEDIATE

PRODUCTION

Form 1002A

Rev. 2009

COMPLETION & TEST DATA BY PRODUCING FORMATION

COMPLETION REPORT

TYPE SIZE

Attach copy of original 1002A 

if recompletion or reentry.

NOTE:

CITY STATE ZIP
PLEASE TYPE OR USE BLACK INK ONLY

FORMATION RECORD

Give formation names and tops, if available, or descriptions and thickness of formations LEASE NAME

drilled through. Show intervals cored or drillstem tested.

NAMES OF FORMATIONS FOR COMMISSION USE ONLY

ITD on file YES NO

APPROVED DISAPPROVED

2) Reject Codes

Were open hole logs run? yes no

Date Last log was run

Was CO2 encountered? yes no

Was H2S encountered? yes no

Were unusual drilling circumstances encountered? yes no

Other remarks:

640 Acres BOTTOM HOLE LOCATION FOR DIRECTIONAL HOLE

SEC TWP RGE

1/4 1/4 1/4 1/4

BOTTOM HOLE LOCATION FOR HORIZONTAL HOLE: (LATERALS)

LATERAL #1

SEC TWP RGE

1/4 1/4 1/4 1/4

Depth of Total

If more than three drainholes are proposed, attach a Deviation Length

separate sheet indicating the necessary information.

Direction must be stated in degrees azimuth.

Please note, the horizontal drainhole and its end

point must be located within the boundaries of the LATERAL #2

lease or spacing unit. SEC TWP RGE

Directional surveys are required for all

drainholes and directional wells. 1/4 1/4 1/4 1/4

640 Acres Depth of Total

Deviation Length

LATERAL #3

SEC TWP RGE

1/4 1/4 1/4 1/4

Depth of Total

Deviation Length

Feet From 1/4 Sec Lines

Feet From 1/4 Sec Lines

Feet From 1/4 Sec Lines

BHL From Lease, Unit, or Property Line:

FWL

BHL From Lease, Unit, or Property Line:

FSL FWL

TOP

If yes, briefly explain below:

Feet From 1/4 Sec Lines

Measured Total Depth True Vertical Depth

Spot Location

Measured Total Depth

Radius of Turn

Radius of Turn Direction

Radius of Turn Direction

Measured Total Depth True Vertical Depth BHL From Lease, Unit, or Property Line:

FSL

COUNTY

True Vertical Depth

COUNTY

FSL FWL

BHL From Lease, Unit, or Property Line:

Spot Location

Direction

Spot Location

Measured Total Depth True Vertical Depth

COUNTY

Spot Location FSL

COUNTY

FWL

WELL NO.

at what depths?

at what depths?