Gas Storage Report - Form 18

gas Storage Report - Form 18 Department of Mineral Resources Oil and gas Division 600 East Boulevard Dept 474 Bismark, N.D 58505 to 0614 S.F.N 5766 (04 to 2000)

Checkbox option: Amended

please read instructions before filling out Form.

Field: Reset

Field: View

Field: Print

Field: For Month/Year

please submit the original.

Field: Field

Field: Storage Zone

Field: County

Field: Operator

Field: Telephone Number

Field: Address

Field: City

Field: State

Field: Zip Code

Field: Source of Gas

injection data

Field: Well Name and Number

Field: U.I.C Number

Field: Monthly Injection Volume

Field: Bbls or M.C.F

Field: Cumulative Injection Volume

Field: Bbls or M.C.F

Field: Daily Injection Volume

Field: Bbls or M.C.F

Field: Average Daily Injection Pressure (P.S.I)

Field: Total Monthly injection

Field: 0:

Field: Comments

I hereby swear or affirm that the information provided is true, complete and correct as determined from all available records.

Field: Date

Field: Signature

Field: Printed Name

Field: Title

Above Signature Witnessed By

Field: Witness Signature

Field: Witness Printed Name

Field: Witness Title

gas Storage Report - Form 18 S.F.N 5766

1. This report is required as a regular monthly report, regardless of the status of operations.

2. Please refer to Section 43-02-03-61 of the North Dakota Administrative Code regarding reporting requirements for gas storage.

3. The field, operator, well names and numbers, and U.I.C numbers shall coincide with the official records on file with the Commission.

4. All liquid volumes shall be reported as barrels (42 gallons) corrected to 14.73 psia and 60 degrees F. and rounded to the nearest full barrel. All gas volumes shall be reported as M.C.F corrected to 14.73 psia and 60 degrees F.

5. Monthly injection shall be totaled at the end of the report.

6. If this is an amended report, the amended volumes shall be clearly indicated.

7. The original of this report shall be filed with the Department of Mineral Resources, Oil and Gas Division, 600 East Boulevard, Dept. 474, Bismarck, N.D 58505 to 0614, by the fifth day of the second succeeding month.