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COCOG <br />?Mp` waiA.np nin.sro?;!??v? <br />Borehole Geophysical Services <br />WELL INTEGRITY REPORT <br />Date of Test: <br />z erforming Pressure Test: <br />Name of C 'ri <br />Operator: <br />Address: <br />. Telephone Number: State: Zip Code: <br />Wei ame and Number: <br />J?? Field: <br /> <br />Location of Well Qtr Qtr Section Township Range County State <br />WFII nATA <br />Tool Type: <br />u )ll- l •??° 1-1 / 4 > 4 Packer Model: <br />_ <br />%AM - sG - <br />Conti or Rig Unit: Pressure Gauge Model / SN: <br />?7 <br />Well Congtructl n Informatlo (- <br /> <br />Wel Typ (Disposal Well, Production Well, Recovery Well, Other): <br />117 .6i /tJ i <br />Reason for To ( IT, W over, etc.): Type of Test Initial MIT, MIT, Annual MIT, Other): <br /> /t>> /ti <br />f?- <br />BEFORE TEST <br />Casing Pressure: f_ <br />.1..- <br />START OF TEST <br />Starting Surface Casing Fla <br />END OF TEST <br />Ending Surface Casing Flar <br />4 <br />TEST DATA <br />Length of Test: <br />RFSUL TS: <br />Approved MI / /vr' t! l Sl+p?? R4 /9 <br />Failed MIT <br />Conditionally <br />Approved MIT <br />If, <br />• COLOG 810 Quail Street, Suite E <br />A Division of Layne Christensen Co any Lakewood, Colorado 80215 <br />Phone: (303)279.0171 FAX: (303) 278.0135 <br />Completeness Issue Item #4 Attachment