2014-07-11_REPORT - M2008017

• Permit No: M2008017
• IBM Index Class Name: Report
• Doc Date: 7/11/2014
• Doc Name: Field Inspection Form
• From: Oil and Gas Conservation Commission
• To: DRMS
• Media Type: D
• Archive: No

Inspector Name: AXELSON, JOHN
Venting:
Yes/No Comment
Flaring:
Type Satisfactory/Action Required Comment Corrective Action CA Date
Predrill
Location ID: 438070
Site Preparation:
Lease Road Adeq.: Pads: Soil Stockpile:
S/A/V:
Corrective Action: Date: CDP Num.:
Form 2A COAs:
S/A/V: Comment:
CA: Date:
Wildlife BMPs:
S/A/V: Comment:
CA: Date:
Stormwater:
Comment:
Staking:
On Site Inspection (3051:
Surface Owner Contact Information:
Name: Address:
Phone Number: Cell Phone:
Operator Rep. Contact Information:
Landman Name: Phone Number:
Date Onsite Request Received: Date of Rule 306 Consultation:
Request LGD Attendance:
LGD Contact Information:
Name: Phone Number: Agreed to Attend:
Summary of Landowner Issues:
Summary of Operator Response to Landowner Issues:
Onsite Inspection Memorandum Summarizing Discussions at Inspection as Attachment:
Facili
Facility ID: 438070 Type: NONFACILIT API Number: - Status: AC Insp. Status: El
Environmental
Date Run: 711412014 Doc[#667500270] Page 2 of 5