Form C-101 "Application for Permit to Drill, Re-enter, Deepen, Plugback, or Add a Zone" - New Mexico

What Is Form C-101?

This is a legal form that was released by the New Mexico Energy, Minerals and Natural Resources Department - a government authority operating within New Mexico. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on July 18, 2013;
  • The latest edition provided by the New Mexico Energy, Minerals and Natural Resources Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form C-101 by clicking the link below or browse more documents and templates provided by the New Mexico Energy, Minerals and Natural Resources Department.

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District I
State of New Mexico
Form C-101
1625 N. French Dr., Hobbs, NM 88240
Revised July 18, 2013
Phone: (575) 393-6161 Fax: (575) 393-0720
Energy Minerals and Natural Resources
District II
.
811 S. First St., Artesia, NM 88210
Oil Conservation Division
Phone: (575) 748-1283 Fax: (575) 748-9720
AMENDED REPORT
District III
1000 Rio Brazos Road, Aztec, NM 87410
1220 South St. Francis Dr.
Phone: (505) 334-6178 Fax: (505) 334-6170
District IV
Santa Fe, NM 87505
1220 S. St. Francis Dr., Santa Fe, NM 87505
Phone: (505) 476-3460 Fax: (505) 476-3462
APPLICATION FOR PERMIT TO DRILL, RE-ENTER, DEEPEN, PLUGBACK, OR ADD A ZONE
1.
2.
Operator Name and Address
OGRID Number
3.
API Number
4.
5.
6.
Property Code
Property Name
Well No.
7.
Surface Location
UL - Lot
Section
Township
Range
Lot Idn
Feet from
N/S Line
Feet From
E/W Line
County
Proposed Bottom Hole Location
8.
UL - Lot
Section
Township
Range
Lot Idn
Feet from
N/S Line
Feet From
E/W Line
County
9.
Pool Information
Pool Name
Pool Code
Additional Well Information
11.
12.
13.
14.
15.
Work Type
Well Type
Cable/Rotary
Lease Type
Ground Level Elevation
16.
17.
18.
19.
20.
Multiple
Proposed Depth
Formation
Contractor
Spud Date
Depth to Ground water
Distance from nearest fresh water well
Distance to nearest surface water
We will be using a closed-loop system in lieu of lined pits
21.
Proposed Casing and Cement Program
Type
Hole Size
Casing Size
Casing Weight/ft
Setting Depth
Sacks of Cement
Estimated TOC
Casing/Cement Program: Additional Comments
22.
Proposed Blowout Prevention Program
Type
Working Pressure
Test Pressure
Manufacturer
23.
I hereby certify that the information given above is true and complete to the
OIL CONSERVATION DIVISION
best of my knowledge and belief.
I further certify that I have complied with 19.15.14.9 (A) NMAC
and/or
Approved By:
19.15.14.9 (B) NMAC
, if applicable.
Signature:
Printed name:
Title:
Title:
Approved Date:
Expiration Date:
E-mail Address:
Date:
Phone:
Conditions of Approval Attached
District I
State of New Mexico
Form C-101
1625 N. French Dr., Hobbs, NM 88240
Revised July 18, 2013
Phone: (575) 393-6161 Fax: (575) 393-0720
Energy Minerals and Natural Resources
District II
.
811 S. First St., Artesia, NM 88210
Oil Conservation Division
Phone: (575) 748-1283 Fax: (575) 748-9720
AMENDED REPORT
District III
1000 Rio Brazos Road, Aztec, NM 87410
1220 South St. Francis Dr.
Phone: (505) 334-6178 Fax: (505) 334-6170
District IV
Santa Fe, NM 87505
1220 S. St. Francis Dr., Santa Fe, NM 87505
Phone: (505) 476-3460 Fax: (505) 476-3462
APPLICATION FOR PERMIT TO DRILL, RE-ENTER, DEEPEN, PLUGBACK, OR ADD A ZONE
1.
2.
Operator Name and Address
OGRID Number
3.
API Number
4.
5.
6.
Property Code
Property Name
Well No.
7.
Surface Location
UL - Lot
Section
Township
Range
Lot Idn
Feet from
N/S Line
Feet From
E/W Line
County
Proposed Bottom Hole Location
8.
UL - Lot
Section
Township
Range
Lot Idn
Feet from
N/S Line
Feet From
E/W Line
County
9.
Pool Information
Pool Name
Pool Code
Additional Well Information
11.
12.
13.
14.
15.
Work Type
Well Type
Cable/Rotary
Lease Type
Ground Level Elevation
16.
17.
18.
19.
20.
Multiple
Proposed Depth
Formation
Contractor
Spud Date
Depth to Ground water
Distance from nearest fresh water well
Distance to nearest surface water
We will be using a closed-loop system in lieu of lined pits
21.
Proposed Casing and Cement Program
Type
Hole Size
Casing Size
Casing Weight/ft
Setting Depth
Sacks of Cement
Estimated TOC
Casing/Cement Program: Additional Comments
22.
Proposed Blowout Prevention Program
Type
Working Pressure
Test Pressure
Manufacturer
23.
I hereby certify that the information given above is true and complete to the
OIL CONSERVATION DIVISION
best of my knowledge and belief.
I further certify that I have complied with 19.15.14.9 (A) NMAC
and/or
Approved By:
19.15.14.9 (B) NMAC
, if applicable.
Signature:
Printed name:
Title:
Title:
Approved Date:
Expiration Date:
E-mail Address:
Date:
Phone:
Conditions of Approval Attached