FORM 1075 – MECHANICAL INTEGRITY TEST

This presentation will assist you in the completion of the Form The mechanical integrity test. Date of Last Revision: 2009 Rule Requirement: OAC 165:10-5-6(d)(1) Explanation of Form: A pressure or monitoring test must be performed on new and existing enhanced recovery injection wells and disposal wells. Information must be submitted on Form 1075 and witnessed by a Field Inspector. Forms shall be submitted to the Conservation Division's Underground Injection Control Department. [Reference 165:10-5-6] Question concerning this Form: For more information contact Underground Injection Control at (405)

FORM 1075 – MECHANICAL INTEGRITY TEST DATE OF THE TEST

FORM 1075 – MECHANICAL INTEGRITY TEST OPERATOR’S NAME

FORM 1075 – MECHANICAL INTEGRITY TEST OTC/OCC OPERATOR NUMBER

FORM 1075 – MECHANICAL INTEGRITY TEST MAILING ADDRESS, PHONE NUMBER, CITY, STATE, ZIP CODE AND FAX NUMBER OF THE OPERATOR

FORM 1075 – MECHANICAL INTEGRITY TEST TYPE OF TEST: - INITIAL TEST - RETREST - CHANGE OF OPERATOR

FORM 1075 – MECHANICAL INTEGRITY TEST TYPE OF WELL – - COMMERICAL DISPOSAL - NON-COMMERICAL DISPOSAL - INJECTION

FORM 1075 – MECHANICAL INTEGRITY TEST AUTHORIZING OCC ORDER NUMBER

FORM 1075 – MECHANICAL INTEGRITY TEST ADDITIONAL ORDER NUMBERS

FORM 1075 – MECHANICAL INTEGRITY TEST WELL NAME AND NUMBER

FORM 1075 – MECHANICAL INTEGRITY TEST API NUMBER

FORM 1075 – MECHANICAL INTEGRITY TEST LATITUDE AND LONGITUDE

FORM 1075 – MECHANICAL INTEGRITY TEST LOCATION OF THE WELL – - QUARTER SECTION CALLS - SECTION - TOWNSHIP - RANGE - COUNTY

FORM 1075 – MECHANICAL INTEGRITY TEST UNIT NAME AND UNIT ORDER NUMBER

FORM 1075 – MECHANICAL INTEGRITY TEST REWORK PRIOR TO TEST? PLEASE ATTACH A COPY OF AN EXPLANATION IF MORE SPACE IS REQUIRED

FORM 1075 – MECHANICAL INTEGRITY TEST PRESSURE TEST - PASS - FAIL

FORM 1075 – MECHANICAL INTEGRITY TEST CASING/TUBULAR ANNULUS TESTED?

FORM 1075 – MECHANICAL INTEGRITY TEST SURFACE CASING PRESSURE BEFORE TEST

FORM 1075 – MECHANICAL INTEGRITY TEST TUBULAR PRESSURE BEFORE TEST

FORM 1075 – MECHANICAL INTEGRITY TEST ANNULUS PRESSURE BEFORE TEST

FORM 1075 – MECHANICAL INTEGRITY TEST FLOW-BACK VOLUME

FORM 1075 – MECHANICAL INTEGRITY TEST MAXIMUM PRESSURE PER OCC ORDER

FORM 1075 – MECHANICAL INTEGRITY TEST PACKER DEPTH PER OCC ORDER

FORM 1075 – MECHANICAL INTEGRITY TEST ACTUAL PACKER DEPTH

FORM 1075 – MECHANICAL INTEGRITY TEST ESTIMATED PACKER DEPTH

FORM 1075 – MECHANICAL INTEGRITY TEST STARTING TEST PRESSURE

FORM 1075 – MECHANICAL INTEGRITY TEST ENDING TEST PRESSURE

FORM 1075 – MECHANICAL INTEGRITY TEST POSITIVE ANNULUS PRESSURE MONITORING?

FORM 1075 – MECHANICAL INTEGRITY TEST IS THE WELL SHUT DOWN? - YES (GIVE REASON) - NO

FORM 1075 – MECHANICAL INTEGRITY TEST ALTERNATIVE TESTING PROCEDURE AUTHORIZED BY OCC ORDER NUMBER

FORM 1075 – MECHANICAL INTEGRITY TEST PASS / FAIL - TRACER SURVEY - FLUID LEVEL - TUBING PRESSURE - FLUID DEPRESSION

FORM 1075 – MECHANICAL INTEGRITY TEST CASING PATCHED OR SQUEEZED

FORM 1075 – MECHANICAL INTEGRITY TEST IF YES TO CASING PATCHED OR SQUEEZED INDICATE TYPE - MECHANICAL CASING PATCH - CEMENT SQUEEZE - REMEDIAL FLUID - PROVIDE A DESCRIPTION

FORM 1075 – MECHANICAL INTEGRITY TEST PRINTED NAME OF PERSON DOING THE TEST

FORM 1075 – MECHANICAL INTEGRITY TEST SIGNATURE OF COMPANY REPRESENTATIVE

FORM 1075 – MECHANICAL INTEGRITY TEST WITNESS STATEMENT BY OCC FIELD INSPECTOR

FORM 1075 – MECHANICAL INTEGRITY TEST SIGNATURE BLOCK OF OCC FIELD INSPECTOR