Laserfiche WebLink
UNTIED STATES E NVIRONMEMAL PROTECTION AGENCY loan Approvetl <br />WASHINGTON, DC 10460 OMB No. 1000-0042 <br />E PA COMPLETION REPORT FOR BRINE DISPOSAL, <br />~ Approvaleapires9-30-86 <br />. <br />HYDROCARBON STORAGE, OR ENHANCED RECOVERY WELL <br />NAME AND ADDRESS OF E%IS71NG PERMfREE NAME AND ADDRESS OF SURFACE OWNER <br /> S1ATE COUNTY PERMIT NUMBER <br /> LOCATE WELL AND OInLINE UNIT ON <br /> SECTION PLAT - 640 PCRES <br /> SURFACE IOCAT10N DESCRIPTION <br /> N +A OF MOF V. SECTION TOWNSHIP RANGE <br /> -~~~ ~~~ LOCATE WE4 IN 7W0 DIRECTIONS FROM NEAREST LINES OF QUARTER SECTION AND DRILLING UNR <br /> SuAatt <br /> TT,T TTT Location _ h. from (N/S) ~ Line of puaner section <br />If ~ ~I I ~ and_fi. lrom E -line of vaner section <br />WELL ACTIVITY TYPE OF PERMR <br /> <br />W E ^ Brine Disposal ^ Indivitluel Estimated Fracture Pressure <br />^ Enhanced Recovery ^ Area Ot Injection Zone <br />1--~-L i i I ^ Hydrocaroon Storage Number of Wells <br /> y Amicipated Daily Injenion Volume IBbls) Injenion Interval <br />~~~ I ~~ Average Meaimum Feet to Feet <br />1J 1 . ~-- ~ - ~- <br /> Antici aced Dail Injenion Presswe PSI Depth to Bottom o1 Lowermost Freahweter Formation <br />S Average Me>timum (Feet) <br />Type o1 Injenion Fluid /Chad the appropriate a/oca(s// <br />^ Salt Water ^ Brackish Water ^ Fresh Water Leese Name Well Number <br />^ L'quid Nytlrocarbon ^ Other Nema of Injenion Zone <br />Date Drilling Bogen Date Well Completed Permeability o1 Injenion Zone <br />Date Drillirtp Compktatl Porosity of Injenion Zone <br />r <br />CASING PND TUBING CEMENT HOLE <br />OD Sire W/Ft -Grade - New or Used Depth Sacks Clasa Depth BU Diameter <br /> <br /> <br /> <br /> <br /> <br /> <br />INJECTION LONE STIMULATION - W9RE LINE LOGS, LIST FACR TYPE <br />Interval Treated Materiels entl Amount Usetl Log Types lopped Intervsk <br /> <br /> <br /> <br /> <br /> <br /> <br />Complete Anachments A - E listed on the reverse. <br />CERTIFICATION <br />/certify under the penalty o1 law that l hove personally examined and am lamiliar with the information <br />submitted in this document and a// attachments and that, based on my inquiry of those individuals <br />immediate/y responsible for obtaining the information, l believe that the information is true, accurate, <br />andcomplete. /am aware that there are significant penalties for submitting false information, including <br />the possibility of line and imprisonment. /Rel. 40 CfR 144.32). <br />NAME AND OFFICb4l TRLE /Please tYPe or prinU DATE SIGNED <br />