U.S. Department of the Interior |
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Submit original plus THREE copies, |
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OMB Control No. 1010-0141 |
Bureau of Ocean Energy Management, |
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with ONE copy marked "Public Information." |
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OMB Approval Expires XX/XX/XXXX |
Regulation and Enforcement (BOEMRE) |
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Application for Permit to Drill (APD) |
1. |
PROPOSAL TO DRILL |
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2. BOEMRE OPERATOR NO. |
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3. OPERATOR NAME and ADDRESS |
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NEW WELL |
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SIDETRACK |
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BYPASS |
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DEEPEN |
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(Submitting office) |
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4. WELL NAME (CURRENT) |
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5. SIDETRACK NO. (CURRENT) |
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6. BYPASS NO. (CURRENT) |
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7. PROPOSED START DATE |
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8. PLAN CONTROL NO. (NEW WELL ONLY) |
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9. API WELL NO. (CURRENT SIDETRACK / BYPASS) (12 DIGITS) |
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10. |
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Revision |
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11. |
If revision, please list changes: |
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WELL AT TOTAL DEPTH (PROPOSED) |
WELL AT SURFACE |
12. LEASE NO. |
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17. LEASE NO. |
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13. AREA NAME |
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18. AREA NAME |
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14. BLOCK NO. |
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19. BLOCK NO. |
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15. LATITUDE |
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16. LONGITUDE |
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20. LATITUDE |
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21. LONGITUDE |
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( NAD 83 / NAD 27)
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( NAD 83 / NAD 27)
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( NAD 83 / NAD 27)
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( NAD 83 / NAD 27)
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LIST OF SIGNIFICANT MARKERS ANTICIPATED |
22. NAME |
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23. TOP (MD) |
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24. TOP (TVD) |
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22. NAME |
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23. TOP (MD) |
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24. TOP (TVD) |
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25. LIST ALL ATTACHMENTS (Attach complete well prognosis + attachments required by 30 CFR 250.414 or 30 CFR 250.1617(c) and (d) as appropriate.) |
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26. CONTACT NAME |
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27. CONTACT TELEPHONE NO. |
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28. CONTACT E-MAIL ADDRESS |
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29. AUTHORIZING OFFICIAL (Type or print name) |
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30. TITLE |
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31. AUTHORIZING SIGNATURE |
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32. DATE |
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THIS SPACE FOR BOEMRE USE ONLY |
APPROVED: |
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BY |
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TITLE |
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With Attached Conditions |
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Without Conditions |
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DATE |
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API WELL NO. ASSIGNED TO THIS WELL |
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BOEMRE |
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FORM 0123 |
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(Mo/Year - Supersedes all previous versions of Form 0123 which may not be used.) |
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Page 1 of 2 |
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Application for Permit to Drill (APD) Information Sheet |
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33) Question Information Sheet |
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Questions |
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Response |
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Remarks |
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A) Will you maintain quantities of mud and mud material (including weight materials and additives) sufficient to raise the entire system mud weight 1/2 ppg or more? |
YES
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NO
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N/A
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B) If hydrocarbon-based drilling fluids were used, is the drilling rig outfitted for zero discharge and will zero discharge procedures be followed? |
YES
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NO
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N/A
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C) If drilling the shallow casings strings riserless, will you maintain kill weight mud on the rig and monitor the wellbore with an ROV to ensure that it is not flowing? |
YES
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NO
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N/A
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D) If requesting a waiver of the conductor casing, have you submitted a log to BOEMRE G&G that is with in 500 feet of the proposed bottom hole location for the proposed surface casing point? |
YES
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NO
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N/A
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E) Will the proposed operation be covered by an EPA Discharge Permit? (please provide permit number in remarks for this question) |
YES
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NO
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N/A
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F) Will all wells in the well bay and related production equipment be shut-in when moving on to or off of an offshore platform, or from well to well on the platform? If not, please explain. |
YES
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NO
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N/A
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G) Is the calculated daily volume possible from an uncontrolled blowout of this well greater than the daily volume included in the worst case discharge scenario in the approved oil spill response plan? |
YES
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NO
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N/A
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BOEMRE Form 0123 (Mo/Year - Supersedes all previous versions of this form which may not be used.) Page 2 of 2 |
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PAPERWORK REDUCTION ACT OF 1995 (PRA) STATEMENT: The PRA (44 U.S.C. 3501 et seq) requires us to inform you that we collect this information to obtain knowledge of equipmenet and procedures to be used in drilling operations. BOEMRE uses the information to evaluate and approve or disapprove the adequacy of the equipment and/or procedures to safely perform the proposed drilling operation. Responses are mandatory (43 U.S.C. 1334). Proprietary data are covered under 30 CFR 250.197. 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 BOEMRE Forms 0123 and 0123S are estimated to average 100 hours per response. This includes the time for reviewing the instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to the Information Collection Clearance Officer, Mail Stop 5438, Bureau of Ocean Energy Management, Regulation and Enforcement, 1849 C Street, NW, Washington, DC 20240. |
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