Form BSEE-0128 "Semiannual Well Test Report (Swtr)"

What Is Form BSEE-0128?

This is a legal form that was released by the U.S. Department of the Interior - Bureau of Safety and Environmental Enforcement on January 1, 2019 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2019;
  • The latest available edition released by the U.S. Department of the Interior - Bureau of Safety and Environmental Enforcement;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form BSEE-0128 by clicking the link below or browse more documents and templates provided by the U.S. Department of the Interior - Bureau of Safety and Environmental Enforcement.

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Download Form BSEE-0128 "Semiannual Well Test Report (Swtr)"

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U.S. Department of the Interior
OMB Control Number 1014-0019
Submit ORIGINAL plus ONE copy marked “Public Information”.
Bureau of Safety and Environmental Enforcement (BSEE)
OMB Approval Expires 01/31/2023
SEMIANNUAL WELL TEST REPORT (SWTR)
1. TYPE OF SUBMITTAL
188. CHECK ONE ONLY
8. FIELD NAME
11. OPERATOR NAME and ADDRESS
ORIGINAL
OIL WELLS
*GAS WELLS
(Submitting Office)
CORRECTION
* (Required for gas wells only)
189. REPORTING PERIOD STARTING DATE
190. UNIT NO. (if applicable)
10. BSEE ASSIGNED OPERATOR NO.
100.
96.
99.* SHUT-IN
93.
108. API Oil/
105. NET OIL/
106. NET
107. NET
FLOWING
102.* LINE
4. LEASE
2. API WELL NUMBER/
92. DATE OF
CHOKE
3. WELL NAME
WELLHEAD
PRODUCTION
CONDENSATE
CONDENSATE
GAS
WATER
TUBING
PRESSURE
NUMBER
PRODUCING INTERVAL CODE
TEST
SIZE
(BBLS/DAY)
(MCF/DAY)
(BBLS/DAY)
PRESSURE
PRESSURE
(PSIG)
METHOD
GRAVITY
(PSIG)
(64THS)
(PSIG)
FOR BSEE USE ONLY
26. CONTACT NAME
28. AUTHORIZING OFFICIAL
(Type or print name)
29. TITLE
DATA ACCEPTED
27. CONTACT TELEPHONE NO.
30. AUTHORIZING SIGNATURE
31. DATE
DATE
CERTIFICATION: I certify that the information submitted is complete and accurate to the best of my knowledge. I understand that making a false statement may
subject me to the criminal penalties of 18 U.S.C. 1001.
Name and Title: ________________________________________
Date: ________________________
PAPERWORK REDUCTION ACT OF 1995 (PRA) STATEMENT: The PRA (44 U.S.C. 3501 et seq.) requires us to inform you that we collect this information to evaluate the results of well test. BSEE uses this information to determine if reservoirs are being depleted in
a manner that will lead to the greatest ultimate recovery of hydrocarbons and to ascertain that oil and gas wells continue to be capable of producing maximum production rates if assigned. Responses are mandatory (43 U.S.C. 1334). Proprietary data are covered under
30 CFR 250.197. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB Control Number. Public reporting burden for this form is estimated to average 0.1 to 3 hours per
form depending on the number of well tests reported, including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to the Information
Collection Clearance Officer, Bureau of Safety and Regulatory Enforcement, 381 Elden Street, Herndon, VA 20170.
BSEE
FORM BSEE-0128
(January/2019 – Supersedes all previous versions of this form which may not be used).
Page 1 of 1
U.S. Department of the Interior
OMB Control Number 1014-0019
Submit ORIGINAL plus ONE copy marked “Public Information”.
Bureau of Safety and Environmental Enforcement (BSEE)
OMB Approval Expires 01/31/2023
SEMIANNUAL WELL TEST REPORT (SWTR)
1. TYPE OF SUBMITTAL
188. CHECK ONE ONLY
8. FIELD NAME
11. OPERATOR NAME and ADDRESS
ORIGINAL
OIL WELLS
*GAS WELLS
(Submitting Office)
CORRECTION
* (Required for gas wells only)
189. REPORTING PERIOD STARTING DATE
190. UNIT NO. (if applicable)
10. BSEE ASSIGNED OPERATOR NO.
100.
96.
99.* SHUT-IN
93.
108. API Oil/
105. NET OIL/
106. NET
107. NET
FLOWING
102.* LINE
4. LEASE
2. API WELL NUMBER/
92. DATE OF
CHOKE
3. WELL NAME
WELLHEAD
PRODUCTION
CONDENSATE
CONDENSATE
GAS
WATER
TUBING
PRESSURE
NUMBER
PRODUCING INTERVAL CODE
TEST
SIZE
(BBLS/DAY)
(MCF/DAY)
(BBLS/DAY)
PRESSURE
PRESSURE
(PSIG)
METHOD
GRAVITY
(PSIG)
(64THS)
(PSIG)
FOR BSEE USE ONLY
26. CONTACT NAME
28. AUTHORIZING OFFICIAL
(Type or print name)
29. TITLE
DATA ACCEPTED
27. CONTACT TELEPHONE NO.
30. AUTHORIZING SIGNATURE
31. DATE
DATE
CERTIFICATION: I certify that the information submitted is complete and accurate to the best of my knowledge. I understand that making a false statement may
subject me to the criminal penalties of 18 U.S.C. 1001.
Name and Title: ________________________________________
Date: ________________________
PAPERWORK REDUCTION ACT OF 1995 (PRA) STATEMENT: The PRA (44 U.S.C. 3501 et seq.) requires us to inform you that we collect this information to evaluate the results of well test. BSEE uses this information to determine if reservoirs are being depleted in
a manner that will lead to the greatest ultimate recovery of hydrocarbons and to ascertain that oil and gas wells continue to be capable of producing maximum production rates if assigned. Responses are mandatory (43 U.S.C. 1334). Proprietary data are covered under
30 CFR 250.197. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB Control Number. Public reporting burden for this form is estimated to average 0.1 to 3 hours per
form depending on the number of well tests reported, including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to the Information
Collection Clearance Officer, Bureau of Safety and Regulatory Enforcement, 381 Elden Street, Herndon, VA 20170.
BSEE
FORM BSEE-0128
(January/2019 – Supersedes all previous versions of this form which may not be used).
Page 1 of 1