FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING

This presentation will assist you in the completion of the Form 1003A. The notice of temporary exemption from plugging. Date of Last Revision: 2011 Rule Requirement: OAC 165: Explanation of Form: Form 1003A shall be filed with the appropriate Conservation Division District Office. [Reference 165: and 165: ] Question concerning this Form: Contact your Local District Office

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING READ INSTRUCTIONS

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING CHECK BOX ON WHETHER THIS IS AN ORIGINAL, AN AMENDMENT OR A RENEWAL APPLICATION AND WHAT THE ORIGINAL APPLICATION DATE IS

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING OPERATOR’S NAME, ADDRESS AND OPERATOR’S NUMBER

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING LEASE/WELL NAME AND NUMBER

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING API NUMBER

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING OTC (OKLAHOMA TAX COMMISSION) LEASE NUMBER

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING SPOT LOCATION AND FOOTAGE FROM THE SOUTH AND THE WEST LINES OF THE ¼ SECTION

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING LEGAL LOCATION

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING COUNTY WHERE THE WELL IS LOCATED

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING DATE THE WELL WAS COMPLETED

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING DATE OF LAST PRODUCTION/USED AS UTILITY WELL

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING IS WELL LOCATED ON A VALID OR PRODUCING LEASE OR UNIT

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING DEPTH TO THE BASE OF TREATABLE WATER

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING SURFACE CASING SET AT WHAT DEPTH

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING LATEST TEST DATA

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING PRODUCING FORMATION(S) ALONG WITH PERFORATIONS WITH ANY SPACING SIZE/ORDER NUMBER(S)

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING DATES OF EITHER TEMPORARY ABANDONMENT, THE ORIGINAL DATE OF ABANDONED AND HOW LONG IS THE REQUESTED EXEMPTION REQUESTED (Up to 5 years)

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING REASON FOR EXEMPTION FROM PLUGGING

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING METHOD OF TEMPORARY PLUGGING FOR THE PROTECTION OF THE TREATABLE WATER SANDS

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING DATE OF FLUID LEVEL SURVEY

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING FIELD INSPECTOR THAT WITNESSED THE TEMPORARY ABANDONMENT

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING SIGNATURE BLOCK

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING LOCAL DISTRICT OFFICES MAILING ADDRESSES AND PHONE NUMBERS

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING BORE HOLE SCHEMATIC

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING IMPORTANT INFORMATION CONCERNING TEMPORARY ABANDONMENT

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING OCC USE ONLY – Do not write in this box