Form 10-407 Revised 11/2015 CONTINUED ON PAGE 2 Submit ORIGINIAL only

1a. Well Status: Oil SPLUG Other Abandoned Suspended 1b. Well Class:

20AAC 25.105 20AAC 25.110 Development Exploratory

GINJ WINJ WDSPL No. of Completions: __________________ Service Stratigraphic Test

2. Operator Name: 6. Date Comp., Susp., or 14. Permit to Drill Number / Sundry:

Aband.:

3. Address: 7. Date Spudded: 15. API Number:

4a. Location of Well (Governmental Section): 8. Date TD Reached: 16. Well Name and Number:

Surface:

Top of Productive Interval: 9. Ref Elevations: KB: 17. Field / Pool(s):

GL: BF:

Total Depth: 10. Plug Back Depth MD/TVD: 18. Property Designation:

4b. Location of Well (State Base Plane Coordinates, NAD 27): 11. Total Depth MD/TVD: 19. Land Use Permit:

Surface: x- y- ZoneTPI: x- y- Zone- 12. SSSV Depth MD/TVD: 20. Thickness of Permafrost MD/TVD:

Total Depth: x- y- Zone5. Directional or Inclination Survey: Yes (attached) No 13. Water Depth, if Offshore: 21. Re-drill/Lateral Top Window MD/TVD:

 Submit electronic and printed information per 20 AAC 25.050 (ft MSL)

22. Logs Obtained: 

23.

BOTTOM

24. Open to production or injection? Yes No 25.

26.

Was hydraulic fracturing used during completion? Yes No

DEPTH INTERVAL (MD) AMOUNT AND KIND OF MATERIAL USED

27.

Date First Production: Method of Operation (Flowing, gas lift, etc.):

Hours Tested: Production for Gas-MCF:

Test Period

Casing Press: Calculated Gas-MCF: Oil Gravity - API (corr):

Press. 24-Hour Rate

Oil-Bbl: Water-Bbl:

Oil-Bbl:

of completion, suspension, or abandonment, whichever occurs first. Types of logs to be listed include, but are not limited to: mud log, spontaneous potential, 

gamma ray, caliper, resistivity, porosity, magnetic resonance, dipmeter, formation tester, temperature, cement evaluation, casing collar locator, jewelry, and 

perforation record. Acronyms may be used. Attach a separate page if necessary

Date of Test:

Flow Tubing

Water-Bbl: Choke Size: Gas-Oil Ratio:

PRODUCTION TEST

Per 20 AAC 25.283 (i)(2) attach electronic and printed information

CASING WT. PER

FT. GRADE TOP

SETTING DEPTH MD

TOP CEMENTING RECORD

SETTING DEPTH TVD

HOLE SIZE AMOUNT

PULLED

50-

STATE OF ALASKA

ALASKA OIL AND GAS CONSERVATION COMMISSION

WELL COMPLETION OR RECOMPLETION REPORT AND LOG

 WAG

 Gas

BOTTOM

SIZE DEPTH SET (MD) PACKER SET (MD/TVD)

TUBING RECORD

If Yes, list each interval open (MD/TVD of Top and Bottom; Perforation 

Size and Number):

ACID, FRACTURE, CEMENT SQUEEZE, ETC.

CASING, LINER AND CEMENTING RECORD

List all logs run and, pursuant to AS 31.05.030 and 20 AAC 25.071, submit all electronic data and printed logs within 90 days 
Form 10-407 Revised 11/2015 Submit ORIGINAL Only

Conventional Core(s): Yes No Sidewall Cores:

30.

MD TVD

Top of Productive Interval

31. List of Attachments:

32. I hereby certify that the foregoing is true and correct to the best of my knowledge.

Contact: Email:

Printed Name: Title:

Signature: Phone: Date:

General:

Item 1a:

Item 1b:

Item 4b:

Item 9:

Item 15:

Item 20:

Item 22:

Item 23:

Item 24:

Item 27:

Item 28:

Item 30:

Item 31:

Provide a listing of intervals tested and the corresponding formation, and a brief summary in this box. Submit detailed test and analytical 

laboratory information required by 20 AAC 25.071.

Pursuant to 20 AAC 25.070, attach to this form: well schematic diagram, summary of daily well operations, directional or inclination survey, and 

other tests as required including, but not limited to: core analysis, paleontological report, production or well test results.

Report measured depth and true vertical thickness of permafrost. Provide MD and TVD for the top and base of permafrost in Box 29.

Attached supplemental records should show the details of any multiple stage cementing and the location of the cementing tool.

If this well is completed for separate production from more than one interval (multiple completion), so state in item 1, and in item 23 show the 

producing intervals for only the interval reported in item 26. (Submit a separate form for each additional interval to be separately produced, 

showing the data pertinent to such interval).

Provide a listing of intervals cored and the corresponding formations, and a brief description in this box. Pursuant to 20 AAC 25.071, submit 

detailed descriptions, core chips, photographs, and all subsequent laboratory analytical results, including, but not limited to: porosity, 

permeability, fluid saturation, fluid composition, fluid fluorescence, vitrinite reflectance, geochemical, or paleontology.

The Kelly Bushing, Ground Level, and Base Flange elevations in feet above Mean Sea Level. Use same as reference for depth measurements 

given in other spaces on this form and in any attachments.

The API number reported to AOGCC must be 14 digits (ex: 50-029-20123-00-00).

Method of Operation: Flowing, Gas Lift, Rod Pump, Hydraulic Pump, Submersible, Water Injection, Gas Injection, Shut-in, or Other (explain).

This form and the required attachments provide a complete and concise record for each well drilled in Alaska. Submit a well schematic diagram 

with each 10-407 well completion report and 10-404 well sundry report when the downhole well design is changed. All laboratory analytical 

reports regarding samples or tests from a well must be submitted to the AOGCC, no matter when the analyses are conducted.

Information to be attached includes, but is not limited to: summary of daily operations, wellbore schematic, directional or inclination survey, core analysis, 

paleontological report, production or well test results, per 20 AAC 25.070.

Multiple completion is defined as a well producing from more than one pool with production from each pool completely segregated. Each 

segregated pool is a completion.

TPI (Top of Producing Interval).

INSTRUCTIONS

29. GEOLOGIC MARKERS (List all formations and markers encountered): FORMATION TESTS

Review the reporting requirements of 20 AAC 25.071 and, pursuant to AS 31.05.030, submit all electronic data and printed logs within 90 days of 

completion, suspension, or abandonment, whichever occurs first.

Well Class - Service wells: Gas Injection, Water Injection, Water-Alternating-Gas Injection, Salt Water Disposal, Water Supply for Injection, 

Observation, or Other. 

Formation at total depth:

If Yes, list formations and intervals cored (MD/TVD, From/To), and summarize lithology and presence of oil, gas or water (submit separate pages with this form, 

if needed). Submit detailed descriptions, core chips, photographs, and all subsequent laboratory analytical results per 20 AAC 25.071.

 Yes No

Well tested? Yes No 

28. CORE DATA

If yes, list intervals and formations tested, briefly summarizing test results. 

Attach separate pages to this form, if needed, and submit detailed test 

information, including reports, per 20 AAC 25.071.

NAME

Permafrost - Top

Permafrost - Base