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 NAME1/4 1/4 1/4

INCREASED DENSITY ORDER NO. SURFACE COMMINGLED Application Date LOCATION EXCEPTION ORDER ADDRESS SINGLE ZONEGround Latitude (if known) CITY

FORMATION PACKER @ BRAND & TYPE ZIP SPUD DATE OKLAHOMA CORPORATION COMMISSION

PSI DRLG FINISHED DATEOklahoma 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. DATE SIGNATURE Disp, Comm Disp, Svc WEIGHTGRADE 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:

ZIP STATE CITYPLEASE 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 CO2encountered? 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 BHL From Lease, Unit, or Property Line: Measured Total Depth True Vertical Depth 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?