BSEE-0133S Open Hole Data Report (Supplement to the WAR)

U.S. Department of the Interior

OMB Control Number 1014-0018

Bureau of Safety and Environmental

OMB Approval Expires xx/xx/xxxx

Enforcement (BSEE)

OPEN HOLE DATA REPORT (Supplement to the Well Activity Report)

BEGINNING DATE:

ENDING DATE:

REPORT IS NOT TO EXCEED 7 DAYS (1 WEEK) IN DURATION

CORRECTION

CHECK IF THIS IS THE LAST WELL ACTIVITY REPORT

GENERAL INFORMATION

1. API WELL NO. (12 digits)

2. OPERATOR NAME

3. WELL NAME

4. SIDETRACK NO.

5. BYPASS NO.

6. CONTACT NAME / CONTACT TELEPHONE NUMBER / CONTACT E-MAIL ADDRESS

7. OPEN HOLE TOOLS, MUDLOGS, AND DIRECTIONAL SURVEYS

GEOSCIENTIST NAME/ GEOSCIENTIST TELEPHONE NUMBER / GEOSCIENTIST E-MAIL ADDRESS:

Check This Box if Well Total Depth has been reached and this is the Last Logging Run.

SERVICE COMPANY

DATE OPERATIONS COMPLETED

TOOL LOGGING METHOD

LOG TOOL CODE

http://www.bsee.gov/About-BSEE/Procurement-Business-Opportunities/BSEE-OCS-Operation-Forms/tool_code.aspx

INTERVAL DEPTH (MD)

TOP

BOTTOM

8. IDENTIFY OTHER OPEN HOLE DATA COLLECTED

Check the following Data Items if collected in the Borehole (Report when data is acquired)

Velocity Surveys

Vertical Seismic Profile

Conventional Cores/Rotary Sidewall Cores

Percussion Sidewall Samples

If Samples are collected, what analysis will be performed? (Report at completion of borehole)

PVT Analysis

Paleo Analysis

Geochem Analysis

CERTIFICATION: I certify that the information submitted is complete and accurate to the best of my knowledge. I understand that making a false statement may subject me to crimincal penalties under 18 U.S.C. 1001.

Name and Title: __________________________________________________________________________________ Date: ______________________________________________

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 equipment and procedures to be used in drilling operations. BSEE uses the information to evaluate and approve or disapprove the adequacy of the equipment and/or procedures to safely perform the proposed drilling operations. 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 Forms BSEE-0133 and BSEE-0133S is approximately 1 hour per form per response. This includes the time for reviewing 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, Bureau of Safety and Environmental Enforcement, 381 Elden Street, Herndon, VA 20170.

BSEE

FORM BSEE-0133S

(Month/Year - Supersedes all previous versions of this form which may not be used.) Page 1 of 1