140 Bottomhole Pressure Survey Report

U.S. Department of the Interior Minerals Management Service

Submit original plus one copy

OMB Control No. 1010-0041 Expiration Date: 8/31/2008

BOTTOMHOLE PRESSURE SURVEY REPORT

Field

Lease

Well Completion No.

Reservoir Name

Operator Name & Address

API No.

Date of Test

Test Data

Shut-in Time

Bottomhole Temperature

KB Elevation

Shut-in Tubing Pressure

Product (Oil or Gas)

Test Number (1, 2, ….)

THF Elevation to sea level

Perforations

Bottomhole Pressure Points (Attach any additional points)

Measured Depth

True Vertical Depth

Pressure

Pressure Gradient

Company Contact:_______________________________

Phone No. _______________________

REMARKS:______________________________________________________________________________ ________________________________________________________________________________________

Paperwork Reduction Act Statement: The Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.) requires us to inform you that we collect this information to implement the various environmental provisions of the OCS Land Act. We use this information in reservoir engineering calculations for the conservation of natural resources, prevention of waste, and protection of correlative rights including Federal royalty interests. Responses are mandatory (43 U.S.C. 1334). Proprietary data are covered under 30 CFR 250.196. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB Control Number. Public reporting burden for this form is estimated to average 14 hours per response, including the time for lining up the test, performing the test, reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of the form to the Information Collection Clearance Officer, Mail Stop 4230, Minerals Management Service, 1849 C Street, NW, Washington, DC, 20240.

MMS Form MMS-140 (Oct 2005 – Supersedes all previous versions of form MMS-140 which may not be used). Page 1 of 1