Form BSEE-0128 Semiannual Well Test Report

U.S. Department of the Interior Bureau of Safety and Environmental Enforcement (BSEE)

Submit ORIGINAL plus ONE copy marked “Public Information.”

OMB Control Number 1014-0019 OMB Approval Expires xx/xx/xxxx

SEMIANNUAL WELL TEST REPORT (SWTR)

1. TYPE OF SUBMITTAL □ Original □ Correction

188. CHECK ONE ONLY □ OIL WELLS □ *GAS WELLS * (Required for gas wells only)

8. FIELD NAME

11. OPERATOR NAME and ADDRESS (Submitting Office)

189. REPORTING PERIOD STARTING DATE

190. UNIT NO. (if applicable)

10. BSEE ASSIGNED OPERATOR NO.

4. LEASE NUMBER

3. WELL NAME

2. API WELL NUMBER/ PRODUCING INTERVAL CODE

105. NET OIL/ CONDENSATE (BBLS/DAY)

106. NET GAS (MCF/DAY)

107. NET WATER (BBLS/DAY)

96. CHOKE SIZE (64THS)

100. FLOWING TUBING PRESSURE (PSIG)

99.* SHUT-IN WELLHEAD PRESSURE (PSIG)

102.* LINE PRESSURE (PSIG)

93. PRODUCTION METHOD

108. API Oil/ CONDENSATE GRAVITY

92. DATE OF TEST

26. CONTACT NAME

28. AUTHORIZING OFFICIAL (Type or print name)

29. TITLE

FOR BSEE USE ONLY DATA ACCEPTED

27. CONTACT TELEPHONE NO.

30. AUTHORIZING SIGNATURE

31. DATE

DATE

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 the criminal penalties of 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 evaluate the results of well test. BSEE uses this information to determine if reservoirs are being depleted in a manner that will lead to the greatest ultimate recovery of hydrocarbons and to ascertain that oil and gas wells continue to be capable of producing maximum production rates if assigned. 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 this form is estimated to average 4 hours per form depending on the number of well tests reported, including 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 Regulatory Enforcement, 381 Elden Street, Herndon, VA 20170.

BSEE

FORM BSEE-0128 (Mo/Year – Supersedes all previous versions of this form which may not be used).

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