Form MO780-0215 "Oil and Gas Well Completion or Recompletion Report and Well Log - Geological Survey Program" - Missouri

What Is Form MO780-0215?

This is a legal form that was released by the Missouri Department of Natural Resources - a government authority operating within Missouri. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2018;
  • The latest edition provided by the Missouri Department of Natural Resources;
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  • Fill out the form in our online filing application.

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Download Form MO780-0215 "Oil and Gas Well Completion or Recompletion Report and Well Log - Geological Survey Program" - Missouri

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MISSOURI DEPARTMENT OF NATURAL RESOURCES
GEOLOGICAL SURVEY PROGRAM
OIL AND GAS WELL COMPLETION OR
RECOMPLETION REPORT AND WELL LOG
WELL OWNER INFORMATION
NAME OF COMPANY, ORGANIZATION, OR INDIVIDUAL THAT DRILLS, MAINTAINS, OPERATES, OR CONTROLS OIL AND GAS WELLS
OPERATOR LICENSE
IN MISSOURI
REPORT FOR (SELECT ONE)
New well construction
Recompletion/Modification to existing well
Explain: ___________________________________________________
WELL INFORMATION
PRODUCTION UNIT (LEASE OR SURFACE UNIT
GROUND ELEVATION
GEOLOGIC STRATUM NAME (USE MISSOURI
WELL NUMBER
PERMIT NUMBER
API NUMBER
NOMENCLATURE)
NAME)
FT.
WELL USE (SELECT ONE)
Production Well
Oil
Commercial gas
Non-commercial gas
Coalbed methane
Injection Well
Enhanced oil recovery
Disposal of formation fluids
Cyclic steam stimulation
Other (explain in comments box)
Other Well Usage
Stratigraphic test
Observation for ___________________________________
Other (explain in comments box)
IS THIS A MULTIPLE-COMPLETED WELL?
No
Yes (multiple-completed wells are subject to conditions of 10 CSR 50-2.040(5))
WELL ORIENTATION (SELECT ONE; IF HORIZONTAL WELL, ATTACH DIRECTIONAL SURVEY)
Vertical Well
Total depth
_______________ ft.
Plug back depth
______________ ft.
Horizontal Well
Measured vertical depth
_______________ ft.
Horizontal borehole length ______________ ft.
LOCATION OF WELL
LAND GRANT
COUNTY
Was drilling location moved up to fifty feet (50’) from the
approved location? (If yes, attach map per 10 CSR 50-
Sec
Twp.
N Rng
E
W
2.030(3)(C))
Yes
No
.
.
LOCATION OF VERTICAL WELL (NAD83, DECIMAL DEGREES)
LOCATION OF HORIZONTAL WELL TERMINUS (NAD83, DECIMAL DEGREES)
Latitude
Longitude
Latitude
Longitude
DATE SPUDDED
DATE TOTAL DEPTH REACHED DATE COMPLETED READY TO PRODUCE OR INJECT CURRENT STATUS OF WELL
Active
Shut-in (complete)
Shut-in (incomplete)
PRODUCTION OR INJECTION STRATUM FOR THIS COMPLETION OR RECOMPLETION (USE MISSOURI NOMENCLATURE)
TYPE OF ELECTRIC OR OTHER LOGS RAN
Log(s) on file
Log(s) attached
WELL AND WELLHEAD CONSTRUCTION
Type of Well Completion
Perforated casing
Open hole
Open hole depth interval: from
to
.
FT.
FT
Casing Information
Casing Type
Borehole
Casing Depth
Casing Diameter Weight Per Foot Full Length Cement
Diameter
Yes
No (Explain)
Yes
No (Explain)
Yes
No (Explain)
Tubing Information
TUBING DIAMETER
TUBING DEPTH
PACKER DEPTH
PACKER DIAMETER
PACKER TYPE
ANTI-CORROSIVE ANNULAR FLUID
IN.
FT.
FT.
IN.
Perforation Information
Perforation
Perforation
Perforation Type
Perforation
Perforation
Perforation
Perforations Per
Geologic Stratum Name
Top
Bottom
Diameter
Width
Length
Foot
(use Missouri nomenclature)
Round
Slotted
Round
Slotted
Round
Slotted
Liner Information
LINER COMPOSITION
CEMENTED
DIAMETER
LINER - DEPTH TO
LINER - DEPTH TO
PERFORATED
DEPTH TO TOP OF
DEPTH TO BOTTOM
TOP
BOTTOM
PERFORATIONS
OF PERFORATIONS
Steel
Yes
Yes
Other _________________
No
No
IN.
FT.
FT.
FT.
FT.
MO 780-0215 (03-18)
SEND COMPLETED FORM TO: MISSOURI DEPARTMENT OF NATURAL RESOURCES, MISSOURI GEOLOGICAL SURVEY,
oilandgas@dnr.mo.gov
GEOLOGIC RESOURCES SECTION, PO BOX 250, ROLLA, MO 65402 PHONE: 573-368-2100 FAX: 573-368-2111 EMAIL:
MISSOURI DEPARTMENT OF NATURAL RESOURCES
GEOLOGICAL SURVEY PROGRAM
OIL AND GAS WELL COMPLETION OR
RECOMPLETION REPORT AND WELL LOG
WELL OWNER INFORMATION
NAME OF COMPANY, ORGANIZATION, OR INDIVIDUAL THAT DRILLS, MAINTAINS, OPERATES, OR CONTROLS OIL AND GAS WELLS
OPERATOR LICENSE
IN MISSOURI
REPORT FOR (SELECT ONE)
New well construction
Recompletion/Modification to existing well
Explain: ___________________________________________________
WELL INFORMATION
PRODUCTION UNIT (LEASE OR SURFACE UNIT
GROUND ELEVATION
GEOLOGIC STRATUM NAME (USE MISSOURI
WELL NUMBER
PERMIT NUMBER
API NUMBER
NOMENCLATURE)
NAME)
FT.
WELL USE (SELECT ONE)
Production Well
Oil
Commercial gas
Non-commercial gas
Coalbed methane
Injection Well
Enhanced oil recovery
Disposal of formation fluids
Cyclic steam stimulation
Other (explain in comments box)
Other Well Usage
Stratigraphic test
Observation for ___________________________________
Other (explain in comments box)
IS THIS A MULTIPLE-COMPLETED WELL?
No
Yes (multiple-completed wells are subject to conditions of 10 CSR 50-2.040(5))
WELL ORIENTATION (SELECT ONE; IF HORIZONTAL WELL, ATTACH DIRECTIONAL SURVEY)
Vertical Well
Total depth
_______________ ft.
Plug back depth
______________ ft.
Horizontal Well
Measured vertical depth
_______________ ft.
Horizontal borehole length ______________ ft.
LOCATION OF WELL
LAND GRANT
COUNTY
Was drilling location moved up to fifty feet (50’) from the
approved location? (If yes, attach map per 10 CSR 50-
Sec
Twp.
N Rng
E
W
2.030(3)(C))
Yes
No
.
.
LOCATION OF VERTICAL WELL (NAD83, DECIMAL DEGREES)
LOCATION OF HORIZONTAL WELL TERMINUS (NAD83, DECIMAL DEGREES)
Latitude
Longitude
Latitude
Longitude
DATE SPUDDED
DATE TOTAL DEPTH REACHED DATE COMPLETED READY TO PRODUCE OR INJECT CURRENT STATUS OF WELL
Active
Shut-in (complete)
Shut-in (incomplete)
PRODUCTION OR INJECTION STRATUM FOR THIS COMPLETION OR RECOMPLETION (USE MISSOURI NOMENCLATURE)
TYPE OF ELECTRIC OR OTHER LOGS RAN
Log(s) on file
Log(s) attached
WELL AND WELLHEAD CONSTRUCTION
Type of Well Completion
Perforated casing
Open hole
Open hole depth interval: from
to
.
FT.
FT
Casing Information
Casing Type
Borehole
Casing Depth
Casing Diameter Weight Per Foot Full Length Cement
Diameter
Yes
No (Explain)
Yes
No (Explain)
Yes
No (Explain)
Tubing Information
TUBING DIAMETER
TUBING DEPTH
PACKER DEPTH
PACKER DIAMETER
PACKER TYPE
ANTI-CORROSIVE ANNULAR FLUID
IN.
FT.
FT.
IN.
Perforation Information
Perforation
Perforation
Perforation Type
Perforation
Perforation
Perforation
Perforations Per
Geologic Stratum Name
Top
Bottom
Diameter
Width
Length
Foot
(use Missouri nomenclature)
Round
Slotted
Round
Slotted
Round
Slotted
Liner Information
LINER COMPOSITION
CEMENTED
DIAMETER
LINER - DEPTH TO
LINER - DEPTH TO
PERFORATED
DEPTH TO TOP OF
DEPTH TO BOTTOM
TOP
BOTTOM
PERFORATIONS
OF PERFORATIONS
Steel
Yes
Yes
Other _________________
No
No
IN.
FT.
FT.
FT.
FT.
MO 780-0215 (03-18)
SEND COMPLETED FORM TO: MISSOURI DEPARTMENT OF NATURAL RESOURCES, MISSOURI GEOLOGICAL SURVEY,
oilandgas@dnr.mo.gov
GEOLOGIC RESOURCES SECTION, PO BOX 250, ROLLA, MO 65402 PHONE: 573-368-2100 FAX: 573-368-2111 EMAIL:
Well Stimulation (Attach Ticket)
STIMULATION TYPE
MATERIAL USED
AMOUNT
barrels
Acidize
gallons
Explosive
Hydraulic Fracture
__________________________
pounds
Cement Squeeze (Attach Ticket)
SACKS OF CEMENT
SQUEEZE DEPTH INTERVAL TOP
SQUEEZE DEPTH INTERVAL BOTTOM
DATE OF SQUEEZE
FT.
FT.
INITIAL PRODUCTION
DATE OF FIRST PRODUCTION OR INJECTION
PRODUCTION METHOD ( IF PUMPING, SHOW SIZE AND TYPE OF PUMP)
Flowing
Gas Lift
Pumping ______________________________________________________
DATE OF TEST
HOURS TESTED
CHOKE SIZE
TUBING PRESSURE
CASING PRESSURE
OIL PRODUCED DURING TEST
GAS PRODUCED DURING TEST
WATER PRODUCED DURING TEST
OIL GRAVITY
CALCULATED RATE OF PRODUCTION PER 24 HRS
BBLS
MCF
BBLS
API
Oil ________ BBLS
Gas ________ MCF
Water ________ BBLS
GAS/OIL RATIO
WATER/OIL RATIO
WATER/GAS RATIO
TREATMENT OF PRODUCED GAS
Vented
Used for fuel
Sold
Other ____________________________________
METHOD OF DISPOSAL OF MUD PIT CONTENTS
COMMENTS
INFORMATION REQUIRED FOR SUBMISSION
The construction of this well must comply with the specification set forth in the Missouri Code of State Regulations Oil and Gas Council
Rules, specifically 10 CSR 50-2.040 and 10 CSR 50-2.050. All requested information, including information requested/required by the
permit to drill or modify application associated with this well, must be submitted with this form. This information may include but is not
limited to the following:
Driller’s log
Drilling time logs
E-logs
Radioactive logs
Lithologic log
Cuttings on five foot interval
Drill core
Water samples
Core analysis
Drill stem test
Directional survey for horizontal wells
Other information as required
CERTIFICATION
I, the undersigned, certify that:
I am authorized to act as an agent for the applicant of this well.
The information on this form has been reviewed by me and is true, correct and complete to the best of my knowledge.
PRINT NAME
TITLE
COMPANY
PRIMARY PHONE NUMBER WITH AREA CODE
EMAIL ADDRESS
SIGNATURE
DATE
MO 780-0215 (03-18)
SEND COMPLETED FORM TO: MISSOURI DEPARTMENT OF NATURAL RESOURCES, MISSOURI GEOLOGICAL SURVEY,
oilandgas@dnr.mo.gov
GEOLOGIC RESOURCES SECTION, PO BOX 250, ROLLA, MO 65402 PHONE: 573-368-2100 FAX: 573-368-2111 EMAIL:
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