Sundry Notices and Reports on Wells - Form 4

Sundry Notices and Reports on Wells - Form 4 Department of Mineral Resources Oil and Gas Division 600 East Boulevard Dept 474 Bismark, N.D 58505 to 0614 S.F.N 5749 (03 to 2018)

Field: Well File No.

Please Read Instructions Before Filling Out Form.

Please Submit the Original.

Field: Reset

Field: View

Field: Print

Checkbox option: Notice of Intent

Field: Approximate Start Date

Checkbox option: Drilling Prognosis

Checkbox option: Spill Report

Checkbox option: Redrilling or Repair

Checkbox option: Shooting

Checkbox option: Casing or Liner

Checkbox option: Acidizing

Checkbox option: Plug Well

Checkbox option: Fracture Treatment

Checkbox option: Supplemental History

Checkbox option: Change Production Method

Checkbox option: Temporarily Abandon

Checkbox option: Reclamation

Checkbox option: Report of Work Done

Field: Date Work Completed

Checkbox option: Other

Well Name and Number

24-hour Production Rate

Field: Footages

Field: Qtr-Qtr

Field: Section

Field: Township

Field: Range

Field: Before

Field: After

Field: F

Field: L

Field: F

Field: L

Field: N

Field: W

Field: Oil

Field: Bbls

Field: Oil

Field: Bbls

Field: Water

Field: Bbls

Field: Water

Field: Bbls

Field: Gas

Field: M.C.F

Field: Gas

Field: M.C.F

Field: Field

Field: Pool

Field: County

Name of Contractor(s)

Field: Address

Field: City

Field: State

Field: Zip Code

Details of Work

Field: Company

Field: Telephone Number

for State Use Only

Field: Address

Checkbox option: Received

Checkbox option: Approved

Field: City

Field: State

Field: Zip Code

Field: Date

Field: Signature

Field: Printed Name

Field: By

Field: Title

Field: Date

Field: Title

Field: Email Address

Sundry Notices and Reports on Wells - Form 4 S.F.N 5749

1. Approval shall be obtained prior to perforating or completing a well in a reservoir other than the reservoir in which the well is currently completed, prior to plug back of a well, prior to temporary abandonment of a well, prior to abandonment of a well, prior to reclamation of a well site, and prior to reclamation of a reserve pit. Please refer to Section 43-02-03-16 of the North Dakota Administrative Code (N.D.A.C) regarding completing a well in a reservoir other than the reservoir in which the well is currently completed or plugging back of a well, to Section 43-02-03-55 N.D.A.C regarding temporary abandonment of a well, to Section 43-02-03-33 or Section 43-02-05-08 N.D.A.C regarding abandonment of wells, and to Section 43-02-03-34.1 N.D.A.C regarding reclamation redenation.

2. Upon the completion of any remedial work, or attempted remedial work such as plugging back, drilling deeper, acidizing, shooting, formation fracturing, squeezing, operations setting liner, fishing operations, repair work, perforating, reperforating, or other similar operations not specifically covered herein, a report on the operation shall be filed on a Sundry Notice - Form 4 (S.F.N 5749) with the Director. The report shall present a detailed account of all work done and the date of such work; the daily production of oil, gas, and water both prior to and after the operation; the shots per foot, size, and depth of perforations; the quantity of sand, crude, chemical, or other materials employed in the operation; and any other pertinent information or operations which affect the original status of the well and are not specifically covered herein. Please refer to Section 43-02-03-31 N.D.A.C.

3. Upon the initial installation of pumping equipment, or change in type or depth of pumping equipment designed to increase productivity in a well, the operator shall file a Sundry Notice - Form 4 (S.F.N 5749) of such installation. The notice shall include all pertinent information on the pump and the operation thereof including the date of such installation, and the daily production of the well prior to and after the pump has been installed. Please refer to Section 43-02-03-31 N.D.A.C.

4. The well file number, well name and number, well location, field, pool, and county shall coincide with the official records on file with the Commission.

5. 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.