Monthly Treating Plant Report - Form 5p

Monthly Treating Plant Report - Form 5P Department of Mineral Resources Oil and Gas Division 600 East Boulevard Dept 474 Bismark, N.D 58505 to 0614 S.F.N 5753 (05 to 2018)

Field: Plant File Number

Field: Oil Reporting Number

Checkbox option: Amended

Field: For Month/Year

Please Read Instructions Before Filling Out Form.

Please Submit the Original.

Field: Operator

Field: Telephone Number

Field: Address

Field: City

Field: State

Field: Zip Code

Field: Plant Name and Number

Plant Location

Field: Qtr-Qtr

Field: Section

Field: Township

Field: Range

Field: County

Field: Total Liquid Stored (Bbls)

Field: Total Residue Stored (Bbls)

Field: B.S&W

Field: Oil Sold (Bbls)

Field: Water Disposed (Bbls)

Field: Residue Disposed (Bbls or Tons)

Field: Total Residue Stored (Bbls)

Field: Total Liquid Stored (Bbls)

Field: First of Month

Field: First of Month

Field: Received (Bbls)

Field: End of Month

Field: End of Month

B.S&W Source

Field: Well Name and Number or Source Point

Field: File Number or n.d.i.c C.T.B No.

Field: Location (Qtr-Qtr, S-T-R)

Field: B.S&W Taken (Bbls)

Field: Comments

Disposition of Residue

Field: Destination Name

Field: Location (Qtr-Qtr, S-T-R)

Field: Disposed (Bbls or Tons)

Field: Comments

Disposition of Water

Field: Operator

Field: Well Name and Number

Field: File Number

Field: Location (Qtr-Qtr, S-T-R)

Field: Disposed (Bbls)

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

Monthly Treating Plant Report - Form 5P S.F.N 5753

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

2. This completed report shall be signed and witnessed as provided for in Section 43-02-03-52 of the North Dakota Administrative Code (N.D.A.C).

3. Please refer to N.D.A.C Sections 43-02-03-47, 43-02-03-48, and 43-02-03-52 regarding reporting requirements for oil produced and oil sold.

4. The plant file number, oil reporting number, operator, plant name and number, plant location, well names and numbers, well file numbers or central tank battery numbers, and well locations shall coincide with the official records on file with the Commission. All Sources Shall Be Identified with A Location.

5. Under the column headed "Oil Sold" indicate the amount of oil sold from the treating plant. If a portion of the oil was taken from the treating plant by anyone other than the parties listed on the approved Authorization to Purchase and Transport Oil from Lease - Form 8 (S.F.N 5698) on file with the Commission, a proper notation shall be made in the comments section.

6. All barrel volumes shall be reported as barrels (42 gallons), corrected to 14.73 psia and 60 degrees F. All volumes shall be rounded to the nearest full barrel.

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

8. 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, on or before the first day of the second succeeding month. Treating Plants for Which This Report Is Not Received May Be Shut-in.