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~~ <br /> <br />Mechanicallntegrity'Test ' <br />Casing or Annulus Pressure Mechanical Integrity Test <br />U ~. Ernironmeritnl Protection Agency <br />Untlergrountl Injection Control Frogram <br />cog 15"' Street. Suite 560 Denver, CO 502022665 <br />EPA Witness: _ <br />lest conducted by: <br />Others present: _ <br />Well Name: <br />Field: <br />Location: Sec:^ T _ N / S <br />(tnrratnr[ <br />7}ye: ER SWD Status: AC TA UC <br />R_E / W Count)`: State:_ <br />Last M17: ~ / Maximum Alloy+able <br />PS]G <br />Is this a regularh` scheduled test? <br />Initial test for permit? <br />'rest after well rework? <br />Well injecting during test? <br />Pre-test casing/tubing annulus pressure: <br />( ]Yes [ ] No <br />[ ]Yes [ ] No <br />[ )Yes [ j No <br />[ )Yes [ ] No ItYes. rate: <br />psig <br />bpd <br />M]T DATA TABLE Test ~Il 'rest q2 Test tt3 <br />TUBIA'G PRESSURE <br />]nitial Pressure psig psig psig <br />End of test pressure psig psig psig <br />C,9.SIR'G/TUBING AIVA'ULUS PRESSURE <br />0 minutes psig psig psig <br />5 minutes psig psig psig <br />]0 minutes psig psig psig <br />15 minutes psig psig psig <br />20 minutea psig psig psig <br />25 minutes psig psig psig <br />30 minutes psig psig psig <br />minutes psig psig psig <br />minutes psig psig psig <br />RESULT Pass Fail Pass Fail Pass Fail <br />Does the annulus pressure build back up after the test ? [ j Yes [ j No <br />MECHANICAL INTEGRITY PRESSURE TEST <br />Date: / / <br />Additional comments for mechanical integrity pressure tesi, such as volume of fluid added to annulus <br />and bled back at end of test, reason for failing test (casing head leak, tubing leak, other), etc.: <br />