1. FORM 1022A – VACUUM PUMP USE APPLICATION

2. This presentation will assist you in the completion of the Form 1022A. The vacuum use application. Date of Last Revision: 2002 Rule Requirement: 10-3-31 Explanation of Form: Operator shall file one copy of Form 1022A with the required attachments with the Technical Services Department of the Conservation Division. [Reference 165:10-3-31] Question concerning this Form: For more information contact Geology Department at (405) 521-6044.

3. FORM 1022A – VACUUM PUMP USE APPLICATION TYPE OF APPLICATION – WELL or LEASE

4. FORM 1022A – VACUUM PUMP USE APPLICATION CD NUMBER – This item is not needed unless the use is protested and is referred to Administrative Law.

5. FORM 1022A – VACUUM PUMP USE APPLICATION NAME OF OPERATOR

6. FORM 1022A – VACUUM PUMP USE APPLICATION OTC/OCC OPERATOR NUMBER

7. FORM 1022A – VACUUM PUMP USE APPLICATION MAILING ADDRESS, PHONE NUMBER, CITY, STATE, ZIP CODE AND FAX NUMBER

8. FORM 1022A – VACUUM PUMP USE APPLICATION LEASE NAME / NUMBER

9. FORM 1022A – VACUUM PUMP USE APPLICATION NUMBER OF WELLS ON LEASE

10. FORM 1022A – VACUUM PUMP USE APPLICATION LOCATION WITHIN THE SECTION, SECTION, TOWNSHIP AND RANGE ALONG WITH THE COUNTY WHERE THE WELLS ARE LOCATED

11. FORM 1022A – VACUUM PUMP USE APPLICATION API NUMBER

12. FORM 1022A – VACUUM PUMP USE APPLICATION OTC LEASE NUMBER

13. FORM 1022A – VACUUM PUMP USE APPLICATION COMPLETION DATE

14. FORM 1022A – VACUUM PUMP USE APPLICATION TOP OF PAY AVERAGE DEPTH

15. FORM 1022A – VACUUM PUMP USE APPLICATION PRODUCING FORMATION(S)

16. FORM 1022A – VACUUM PUMP USE APPLICATION DATE OF LAST TEST – - Oil (In Barrels) - Water (In Barrels) - Gas (In MCF)

17. FORM 1022A – VACUUM PUMP USE APPLICATION AVERAGE TEST (IF LEASE APPLICATION) - Oil (In Barrels) - Water (In Barrels) - Gas (In MCF)

18. FORM 1022A – VACUUM PUMP USE APPLICATION VACUUM APPLIED FOR – (Indicate if measured in PSIG or Inches of Mercury)

19. FORM 1022A – VACUUM PUMP USE APPLICATION VACUUM BEING PULLED _______ INCHES OF MERCURY

20. FORM 1022A – VACUUM PUMP USE APPLICATION ESTIMATED INCREASE IN PRODUCTION - Oil (In Barrels) - Water (In Barrels) - Gas (In MCF)

21. FORM 1022A – VACUUM PUMP USE APPLICATION PLANNED DISPOSITION OF GAS – CHECK ONE - Sale - Flare - Vent - Fuel Permit Number

22. FORM 1022A – VACUUM PUMP USE APPLICATION NUMBER OF WELLS WITHIN 1 MILE RADIUS ON VACCUM

23. FORM 1022A – VACUUM PUMP USE APPLICATION HAVE OFFSET OPERATORS BEEN NOTIFIED OF THIS APPLICATION? Do not make application unless this item has been completed.

24. FORM 1022A – VACUUM PUMP USE APPLICATION REQUIRED DATA – These items must be attached to this application or it cannot be processed.

25. FORM 1022A – VACUUM PUMP USE APPLICATION OPERATOR’S SIGNATURE BLOCK

26. FORM 1022A – VACUUM PUMP USE APPLICATION FOR OCC USE ONLY – Do Not Write Below this Line