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### State of West Virginia

Department of Environmental Protection

- Office of Oil and Gas

Well Operator’s Report of Well Work

API 4 7

-

____ ___ _ -

__ ____ ____ County

__ _____ __________________ District _

__________________________

Quad

____________________ ________ Pad Name ____________________

____ Field/Pool Name

_ _______ _____ _____

Farm name W ell N umber

__________________________

Operator (as registered with the OOG )

_________________________________________________________

Address _________________________________ City _________________________ State _____________ Zip _____________

As Drille d location NAD 83/UTM Attach an as

- drilled plat, profile view, and deviation survey

Top hole Northing _____________________ Easting

________________________________ Landing Point of Curve Northing _

____________________ Easting ________________________________

Bottom H ole Northing ______________________ Easting _

_______________________________

Elevation (ft) _____________ GL Type of Well □New □ Ex isting Type of Report □Interim □Final

Permit Type □ Deviated □ Horizontal □ Horizontal 6A □ Vertical Depth Type □ Deep □ Shallow

Type of Operation □ Convert □ Deepen □ Drill □ Plug Back □ Redrilling □ Rework □ Stimulate

W ell Type □ Brine Disposal □ CBM □ Gas □ Oil □ Secondary Recovery □ Solution Mining □ Storage □ Other __________

Type of Completion □ Single □ Multiple Fluids Produced □ Brine □Gas □ NGL □ Oil □ Other

__________

Drilled with □ Cable □ Rotary

D rilling Media Surface hole □ Air □ Mud □ Fresh Water Intermediate hole □ Air □ Mud □ Fresh Water □ Brine

Production hole □ Air □ Mud □ Fresh Water □ Brine

Mud Type (s) and Additive(s)

___________________________________________________________________________________________________ _________

_______________________________________________________________________________________________________ _____

Date p ermit issued ________________ Date drilling commenced Date drilling c eased

Date completion activities began _______________________ Date completion activities ceased

______________________

Verbal plugging (Y/N )

__________ Date permission grant ed

___________________ Granted by_________________

_______

Please note : Operator is required to s ubmit a plugging application within 5 days of verbal permission to plug

Freshwater d epth(s) ft

__________ __________________ Open m ine ( s ) (Y/N) d epths _________________________________

S alt water depth(s) ft

______________________________ Void(s) encountered (Y/N) d epths ________________________

___ _

Coal depth(s) ft

_________________________________ Cavern (s) encountered (Y/N) d epths

________ __ _________________

Is coal being mined in area (Y/N) _____________________________

Reviewed by:WR

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____ - _______________ Farm name Well number

CASING Hole Casing New or Grade Basket Did cement circulate (Y/ N)

STRINGS Size Size Depth Used wt/ft Depth(s) * Provide details below*

Conductor

Surface

Coal

Intermediate 1

Intermediate 2

Intermediate 3

Production

Tubing

Packer type and depth set

Comment Details __________________________________________________________________________________________________________

___________

_____________________________________________________________________________________________________________________________ __________

CEMENT Class/Type Number Slurry Yield Volume Cement WOC

DATA of Cement of Sacks wt (ppg) ( ft 3 /sks) (ft 3 ) Top (MD) (hrs)

Conductor

Surface

Coal

Intermediate 1

Intermediate 2

Intermediate 3

Production

Tubing

Drillers TD (ft)

_______________________ ___ __ __ ______ Loggers TD (ft)

_______________ ____ ________________________ Deepest formation pen etrated ________________

__ _______ Plug back to (ft) ___

_________________ ______ ________ ____ _____ Plug back p rocedure

_______________________________________ __________________________ __ _____ __________________

____________________________________________________________________________________________________________

Kick off depth (ft)_______________________________________

Check all wireline logs run □ c aliper □ density □ deviated/ direction al □ induction

□ neutron □ resistivity □ gamma ray □ temperature □sonic

Well cored □ Yes □ No □ C onventional □ Sidewall Were cuttings collected □ Yes □ No

DESCRIBE THE CENTRALIZER PLACEMENT USED FOR EACH CASING STRING

_____ __ ________ _____ _____ _________________

__________________________________________________________________________________________________________________________ _____________

_____________________________________________________________________________________________________________________________ __________

____________________________________________________________________________________________________________ ___________________________

_____________________________________________________________________________________________________________________________ __________

WAS WELL COMPLETED AS SHOT HOLE □ Yes □ No DETAILS

________________ ____ _ __________________ __

_______________________________________________________________________________________________________ _____

WAS WELL COMPLETED OPEN HOLE ? □ Yes □ No DETAILS

_______ __ _ ______________________________ ___

____________ ___________________________________________________________________________________________ _____

WERE TRACERS USED □ Yes □ No TYPE OF TRACER(S) USED

________________________ ___ __

___________ ______________

_____________________________________________________________________________________________________________________________ ________WR

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____ - _______________ Farm name Well number

PERFORATION RECORD

Stage Perforated from Perforated to Number of

No. Perforation date MD ft. MD ft. Perforations Formation(s)

Please insert additional pages as applicable.

STIMULATION INFORMATION PER STAGE

Complete a separate record for each stimulation stage.

Stage Stimulations Ave Pump Ave Treatment Max Breakdown Amount of Amount of Amount of

No. Date Rate (BPM) Pressure (PSI) Pressure (PSI) ISIP (PSI) Proppant ( lbs) Water (bbls) Nitrogen/other (units)

Please insert additional pages as applicable.WR

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____ - _______________ Farm name Well number

PRODUCING FORMATION (S) DEPTHS

_________________ ____________ ______________ T VD

_______________ MD

_____________________________ _______________ _______________

_____________________________ _______________ _______________

_____________________________ _______________ _______________

Please insert additional pages as applicable.

GAS TEST □ Build up □ Drawdown □ Open Flow OIL TEST □ Flow □ Pump

SHUT

- IN PRESSURE Surface _ _________psi Bottom Hole __________psi DURATION OF TEST ________ hrs

OPEN FLOW Gas Oil NGL Water GAS MEASURED BY

□ Estimated □ Orifice □ Pilot mcf p d bpd bpd bpd

LITHOLOGY/ TOP BOTTOM TOP BOTTOM

FORMATION DEPTH IN FT DEPTH IN FT DEPTH IN FT DEPTH IN FT DESCRIBE ROCK TYPE AND RECORD QUANTITYAND

NAME TVD TVD MD MD TYPE OF FLUID (FRESHWATER, BRINE, OIL, GAS, H 2 S, ETC)

0 0

Please insert additional pages as applicable.

Drilling Contractor _______________________________________

Address ____________________________________ City

_____________________ _ State _______ Zip

_________________

Logging Company _

______________________________________ Address ____________________________________ City ______________________ State _______ Zip _________________

Cementing Company __________________________________

_____ Address ____________________________________ City ______________________ State _______ Zip _________________

Stimulating Company

_______________________________________ Address ____________________________________ City _________________ _____ State _______ Zip _________________

Please insert additional pages as applicable.

Completed by

_____________________________________________ Telephone _

_______________________________ Signature _________________________________ Title

________________ _____________ Date

_______________

Submittal of Hydraulic Fracturing Chemical Disclosure Information Attach copy of FRACFOCUS Registry