NATURAL RESOURCES AGENCY OF CALIFORNIA

DEPARTMENT OF CONSERVATION
DIVISION OF OIL, GAS, AND GEOTHERMAL RESOURCES

WELL SUMMARY REPORT

Operator

Well

Field (and Area, if applicable)

County

Sec.

Was the well directionally drilled?

Yes

No

T.

R.

B.&M.

Elevation of ground above sea level:

Location of well (Give surface location from property or section corner, street center line)
Lat./Long. in decimal degrees, to six decimal places, NAD 83 format: Lat:

API No.

Long:

If yes, show coordinates (from surface location) and true vertical depth at total depth.

Commenced drilling (date)

(1st hole)

Total depth
(2nd)

(3rd)

Depth measurements taken from top of:

Derrick Floor
Rotary Table
Kelly Bushing

Completed drilling (date)

Commenced production/injection (date)

Present effective depth

Production mode:

Junk? Describe:

Flowing

Which is
GEOLOGICAL MARKERS

feet above ground.

DEPTH

Pumping
Gas lift
Name of production/injection zone(s)

Formation and age at total depth

Clean Oil
(bbl per day)

API Gravity
(clean oil)

Percent Water
(including emulsion)

Gas
(Mcf per day)

Tubing Pressure

Base of fresh water

Casing Pressure

Initial
Production
Production
After 30 days
Size of Casing
(Inches API)

Top of
Casing

CASING AND CEMENTING RECORD (Present Hole)

Weight of
Grade and Type of
New (N)
Size of
Number of Sacks or
Casing
Casing
or
Hole
Cubic Feet of Cement
Used (U)
Drilled

Depth of Shoe

Depth of Cementing
(if through
perforations)

Top(s) of
Cement in
Annulus

PERFORATED CASING (Size, top, bottom, perforated intervals, size and spacing of perforations, and method.)

Logs/surveys run?

Yes

No

If yes, list type(s) and depth(s).

In compliance with Sec. 3215, Division 3, of the Public Resources Code, the information given herewith is a complete and correct record of
the present condition of the well and all work done thereon, so far as can be determined from all available records.
Name of person filing report

Telephone Number

Address
Individual to contact for technical questions:
OG100 (3/09)

Telephone Number

Signature

Date

City/State

Zip Code

E-Mail Address:

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