FORM 1003/1003C – PLUGGING RECORD

FORM 1003/1003C – PLUGGING RECORD This presentation will assist you in the completion of the Form 1003/1003C. The plugging record. Date of Last Revision: 2011 Rule Requirement: OAC 165:10-11-7 Explanation of Form: Operator will file Form 1003, in duplicate, within 30 days after plugging operations are completed. Both copies are to be mailed to the appropriate Conservation Division District Office. Form 1003 shall be completed and signed by employees of both the operator and the cementer. If a depleted producer, list OTC assigned county and lease number. [Reference 165:10-11-6 and 165:10-11-7] Question concerning this Form: Contact your Local District Office

FORM 1003/1003C – PLUGGING RECORD API NUMBER OF THE WELL

FORM 1003/1003C – PLUGGING RECORD OTC (OKLAHOMA TAX COMMISSION) PRODUCTION UNIT NUMBER

FORM 1003/1003C – PLUGGING RECORD PLUGGING DATE

FORM 1003/1003C – PLUGGING RECORD PLOT THE WELL LOCATION ON THE GRID

FORM 1003/1003C – PLUGGING RECORD WELL NAME AND NUMBER

FORM 1003/1003C – PLUGGING RECORD LEGAL LOCATION

FORM 1003/1003C – PLUGGING RECORD FOOTAGES FROM THE SOUTH OF THE ¼ SECTION AND THE FOOTAGES FROM THE WEST OF ¼ SECTION

FORM 1003/1003C – PLUGGING RECORD COUNTY IN WHICH THE WELL EXISTS

FORM 1003/1003C – PLUGGING RECORD TOTAL DEPTH OF THE WELL

FORM 1003/1003C – PLUGGING RECORD BASE OF TREATABLE WATER (IN FEET)

FORM 1003/1003C – PLUGGING RECORD WELL CLASSIFICATION (GAS, OIL, DRY, INJECTION OR SALTWATER DISPOSAL)

FORM 1003/1003C – PLUGGING RECORD OPERATOR OF THE WELL’S NAME AND OPERATOR’S NUMBER

FORM 1003/1003C – PLUGGING RECORD PIPE INFORAMTION – Size of the Pipe, the Footage of Pipe in the Hole, and the Amount of Pipe Pulled (all amounts should be reported in feet)

FORM 1003/1003C – PLUGGING RECORD PERFORATION DEPTHS

FORM 1003/1003C – PLUGGING RECORD TYPE OF PLUG

FORM 1003/1003C – PLUGGING RECORD HOLE SIZE OR PIPE SIZE

FORM 1003/1003C – PLUGGING RECORD DEPTH

FORM 1003/1003C – PLUGGING RECORD NUMBER OF SACKS OF CEMENT

FORM 1003/1003C – PLUGGING RECORD SLURRY VOLUME

FORM 1003/1003C – PLUGGING RECORD CALCULATED TOP OF CEMENT

FORM 1003/1003C – PLUGGING RECORD MEASURED TOP OF PLUG IF TAGGED

FORM 1003/1003C – PLUGGING RECORD REMARKS CONCERNING THE PLUGGING OF THE WELL AND PROVIDE A REASON WHY THE WELL WAS PLUGGED

FORM 1003/1003C – PLUGGING RECORD CEMENTING COMPANY’S NAME, ADDRESS AND PERMIT NUMBER

FORM 1003/1003C – PLUGGING RECORD OPERATOR’S NAME AND SIGNATURE

FORM 1003/1003C – PLUGGING RECORD OCC USE ONLY – Do not write in this space

FORM 1003/1003C – PLUGGING RECORD INSTRUCTIONS TO COMPLETE THE FORM 1003/1003C

FORM 1003/1003C – PLUGGING RECORD ADDRESSES OF THE FOUR LOCAL DISTRICT OFFICES

FORM 1003/1003C – PLUGGING RECORD OCC USE ONLY – Do not write in this space