Registration For Persons Proving / Testing / Oil Sampling – Form 2b

Registration for Persons Proving / Testing / Oil Sampling - Form 2.B Department of Mineral Resources Oil and Gas Division 600 East Boulevard Dept 474 Bismark, N.D 58505 to 0614 S.F.N (3 to 2015)

Please Read Instructions Before Filling Out Form.

Please Submit the Original:

Field: Full Name of Company or Organization

Field: Telephone Number

Field: Address

Field: City

Field: State

Field: Zip Code

Field: State the Purpose of the Organization (i.e. Producer, Pipeline, Refiner, etcetera)

Enter Information on Persons Proving, Testing Meters or V.P.C.R.m and Oil Sampling Below

Field: Individual Name

Field: Address

Field: Telephone Number

Field: Qualifications, Listing of Experience, or Specific Training:

Field: Individual Name

Field: Address

Field: Telephone Number

Field: Qualifications, Listing of Experience, or Specific Training:

Field: Individual Name

Field: Address

Field: Telephone Number

Field: Qualifications, Listing of Experience, or Specific Training:

Field: Individual Name

Field: Address

Field: Telephone Number

Field: Qualifications, Listing of Experience, or Specific Training:

Field: Individual Name

Field: Address

Field: Telephone Number

Field: Qualifications, Listing of Experience, or Specific Training:

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

Registration for Persons Proving / Testing / Oil Sampling  Form 2.B

1. Please refer to Section 43-02-03-14.2 Paragraph (5) of the North Dakota Administrative Code regarding organization reports.

2. All personnel performing oil proving, testing oil meters, testing for V.P.C.R.4, and oil sampling need to register.

3. This report must be approved before a company or individual is registered to test or prove meters or to perform sampling in the state.

4. 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.