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Mechanical Integrity Test <br />Casing or Annulus Pressure Mechanical Integrity Test <br />U.S. Environmental Proledion Agenry <br />Underground Injection Control Program, UIC Direct Implementation Program 8P~W~6W <br />999 18^ Street, Suite 500 Denver, CO 802022466 <br /> <br />EPA Witness: _ <br />Test conducted by: <br />Others present: _ <br />Well Name: Type: ER SWD Status: AC TA UC <br />Field: <br />Location: Sec:_ T _ N / S R_E / W County: State:_ <br />Operator; <br />Last MIT: / / Maximum Allowable Pressure: PSIG <br />Date: / / <br />Is this a regulazly scheduled test? [ ]Yes <br />Initial test for permit? [ ]Yes <br />Test after well rework? [ ]Yes <br />Well injecting during test? [ ]Yes <br />Pre-test casing/tubing annulus pressure: <br />psig <br />bpd <br />MIT DATA TABLE Test #1 Test #l Test #3 <br />TUBING PRESSURE <br />Initial Pressure si si si <br /> <br />CASING/TUBING ANNULUS PRESSURE <br />0 minutes si si si <br />5 minutes si si si <br />10 minutes si si si <br />15 minutes si si si <br />20 minutes si si si <br />25 minutes si si si <br />30 minutes si si si <br />minutes si si si <br /> <br />RESULT Pass Fail Pass Fail Pass Fail <br />Does the annulus pressure build back up after the test ? [ ]Yes [ ] No <br />Page t o< 2 (over) <br />[ ] No <br />[ ] No <br />[ ] No <br />[ ] No If Yes, rate: <br />