BOEM-0140 Bottomhole Pressure Survey Report

U.S. Department of the Interior Bureau of Ocean Energy Management

Submit one original plus one copy.

OMB Control No.: 1010-0114 Expiration Date: XXXX

BOTTOMHOLE PRESSURE SURVEY REPORT

Field

Lease

Well Name

Reservoir Name

Operator Name & Address

API No. (with completion code)

Date of Test

Test Data

Shut-in Time

Bottomhole Temperature

KB to Sea Level Elevation

KB to THF Elevation

THF to Sea Level Elevation

Product (Oil or Gas)

Test Number (1, 2, ….)

Shut-in Tubing Pressure

Perforations

Bottomhole Pressure Points (Attach any additional points)

Measured Depth from THF

True Vertical Depth from KB

Pressure

Pressure Gradient

COMPANY CONTACT NAME: TELEPHONE NO. _______________________________________________________________________________________ COMPANY CONTACT ADDRESS: EMAIL ADDRESS: _______________________________________________________________________________________ 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 550.197. 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 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, Bureau of Ocean Energy Management, 381 Elden Street, Herndon, VA 20170.

Form BOEM-0140 (Month Year) Page 1 of 1

Previous Editions are Obsolete.