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GENERAL INSTRUCTIONS <br />This form is designed for submitting proposals to perform certain well operations and reports of such operations when completed as <br />indicated on Federal and Indian lands pursuant to applicable Federal law and regulations. Any necessary special instructions concerning the <br />use of this form and the number of copies to be submitted, particularly with regard to local area or regional procedures and practices, are <br />either shown below, will be issued by or may be obtained from the local Federal office. <br />SPECIFIC INSTRUCTIONS <br />Item 4 - Locations on Federal or Indian land should be described in accordance with Federal requirements. Consult the local Federal office <br />for specific instructions. <br />Item 13 - Proposals to abandon a well and subsequent reports of abandonment should include such special information as is required by <br />the local Federal office. In addition, such proposals and reports should include reasons for the abandonment; data on any former or <br />present productive zones or other zones with present significant fluid contents not sealed off by cement or otherwise; depths (top and <br />bottom) and method of placement of cement plugs; mud or other material placed below, between and above plugs; amount, size, method of <br />parting of any casing, liner or tubing pulled and the depth to the top of any tubing left in the hole; method of closing top of well and date <br />well site conditioned for final inspection looking for approval of the abandonment. <br />NOTICES <br />The Privacy Act of 1974 and the regulation in 43 CFR 2.48(d) provide that you be furnished the following information in connection with <br />information required by this application. <br />AUTHORITY: 30 U.S.C. 181 et seq., 351 et seq., 25 U.S.C. 396; 43 CFR 3160. <br />PRINCIPAL PURPOSE: The information is used to: (1) Evaluate, when appropriate, approve applications, and report completion of <br />subsequent well operations, on a Federal or Indian lease; and (2) document for administrative use, information for the management, <br />disposal and use of National Resource lands and resources, such as: (a) evaluating the equipment and procedures to be used during a <br />proposed subsequent well operation and reviewing the completed well operations for compliance with the approved plan; (b) requesting <br />and grantingapproval to perform those actions covered by 43 CFR 3162.3-2, 3162.3-3, and 3162.3-4; (c) reporting the beginning or <br />resumption of production, as required by 43 CFR 3162.4-1(c)and (d) analyzing future applications to drill or modify operations in light <br />of data obtained and methods used. <br />ROUTINE USES: Information from the record and/or the record will be transferred to appropriate Federal, State, local or foreign <br />agencies, when relevant to civil, criminal or regulatory investigations or prosecutions in connection with congressional inquiries or to <br />consumer reporting agencies to facilitate collection of debts owed the Government. <br />EFFECT OF NOT PROVIDING THE INFORMATION: Filing of this notice and report and disclosure of the information is mandatory <br />for those subsequent well operations specified in 43 CFR 3162.3-2, 3162.3-3, 3162.3-4. <br />The Paperwork Reduction Act of 1995 requires us to inform you that: <br />The BLM collects this information to evaluate proposed and/or completed subsequent well operations on Federal or Indian oil and gas <br />leases. <br />Response to this request is mandatory. <br />The BLM would like you to know that you do not have to respond to this or any other Federal agency -sponsored information collection <br />unless it displays a currently valid OMB control number. <br />BURDEN HOURS STATEMENT: Public reporting burden for this form is estimated to average 8 hours per response, including the <br />time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the <br />burden estimate or any other aspect of this form to U.S. Department of the Interior, Bureau of Land Management (1004-0137), Bureau <br />Information Collection Clearance Officer (WO -630),1849 C St., N.W., Mail Stop 401 LS, Washington, D.C. 20240 <br />(Form 3160-5, page'_' <br />