Form 0123 Application for Permit to Drill (APD)

30 CFR 250, Subpart D, Oil and Gas Drilling Operations

Form 0123 exp 2014.XLS

408-418 - Apply for a Permit to Drill

OMB: 1010-0141

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Overview

0123 pg 1
0123 pg 2


Sheet 1: 0123 pg 1

U.S. Department of the Interior











Submit original plus THREE copies,






















OMB Control No. 1010-0141
Bureau of Ocean Energy Management,










with ONE copy marked "Public Information."























OMB Approval Expires XX/XX/XXXX
Regulation and Enforcement (BOEMRE)




































Application for Permit to Drill (APD)
1. PROPOSAL TO DRILL














2. BOEMRE OPERATOR NO.







3. OPERATOR NAME and ADDRESS











NEW WELL


SIDETRACK



BYPASS


DEEPEN











(Submitting office)














































4. WELL NAME (CURRENT)






5. SIDETRACK NO. (CURRENT)







6. BYPASS NO. (CURRENT)














































7. PROPOSED START DATE






8. PLAN CONTROL NO. (NEW WELL ONLY)






















































9. API WELL NO. (CURRENT SIDETRACK / BYPASS) (12 DIGITS)





























































10.
Revision

11. If revision, please list changes:






























WELL AT TOTAL DEPTH (PROPOSED) WELL AT SURFACE
12. LEASE NO.

















17. LEASE NO.



















13. AREA NAME












18. AREA NAME



















14. BLOCK NO.

















19. BLOCK NO.



















15. LATITUDE








16. LONGITUDE







20. LATITUDE







21. LONGITUDE









( NAD 83 / NAD 27)






( NAD 83 / NAD 27)





( NAD 83 / NAD 27)





( NAD 83 / NAD 27)









LIST OF SIGNIFICANT MARKERS ANTICIPATED
22. NAME







23. TOP (MD)



24. TOP (TVD)



22. NAME







23. TOP (MD)



24. TOP (TVD)





















































































































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.)
















































































































26. CONTACT NAME















27. CONTACT TELEPHONE NO.







28. CONTACT E-MAIL ADDRESS
















































29. AUTHORIZING OFFICIAL (Type or print name)















30. TITLE































































































31. AUTHORIZING SIGNATURE















32. DATE





































































































































THIS SPACE FOR BOEMRE USE ONLY
APPROVED:










BY












TITLE












With Attached Conditions




































Without Conditions




























































DATE










API WELL NO. ASSIGNED TO THIS WELL




























































































































































































BOEMRE

FORM 0123



(Mo/Year - Supersedes all previous versions of Form 0123 which may not be used.)























Page 1 of 2




Sheet 2: 0123 pg 2

Application for Permit to Drill (APD) Information Sheet






33) Question Information Sheet

Questions

Response
Remarks

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
NO
N/A









B) If hydrocarbon-based drilling fluids were used, is the drilling rig outfitted for zero discharge and will zero discharge procedures be followed? YES
NO
N/A









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
NO
N/A









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
NO
N/A










E) Will the proposed operation be covered by an EPA Discharge Permit? (please provide permit number in remarks for this question) YES
NO
N/A









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
NO
N/A










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
NO
N/A









BOEMRE Form 0123 (Mo/Year - Supersedes all previous versions of this form which may not be used.) Page 2 of 2
















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.

File Typeapplication/vnd.ms-excel
AuthorAubin P. Buquet
Last Modified Byblundon
File Modified2011-07-12
File Created2002-11-12

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