Form C-104 "Request for Allowable and Authorization to Transport" - New Mexico

What Is Form C-104?

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 August 1, 2011;
  • 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-104 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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Download Form C-104 "Request for Allowable and Authorization to Transport" - New Mexico

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District I
State of New Mexico
Form C-104
1625 N. French Dr., Hobbs, NM 88240
Revised August 1, 2011
Energy, Minerals & Natural Resources
District II
811 S. First St., Artesia, NM 88210
Submit one copy to appropriate District Office
District III
Oil Conservation Division
1000 Rio Brazos Rd., Aztec, NM 87410
1220 South St. Francis Dr.
AMENDED REPORT
District IV
Santa Fe, NM 87505
1220 S. St. Francis Dr., Santa Fe, NM 87505
I.
REQUEST FOR ALLOWABLE AND AUTHORIZATION TO TRANSPORT
1
2
Operator name and Address
OGRID Number
3
Reason for Filing Code/ Effective Date
4
5
6
API Number
Pool Name
Pool Code
30 - 0
7
8
9
Property Code
Property Name
Well Number
10
II.
Surface Location
Ul or lot no. Section Township Range Lot Idn Feet from the North/South Line Feet from the
East/West line
County
11
Bottom Hole Location
UL or lot no. Section Township Range Lot Idn Feet from the North/South line Feet from the
East/West line
County
12
15
16
17
13
14
Lse Code
Producing Method
Gas Connection
C-129 Permit Number
C-129 Effective Date
C-129 Expiration Date
Code
Date
III. Oil and Gas Transporters
18
19
20
Transporter
Transporter Name
O/G/W
OGRID
and Address
IV. Well Completion Data
21
22
23
24
25
26
Spud Date
Ready Date
TD
PBTD
Perforations
DHC, MC
27
28
29
30
Hole Size
Casing & Tubing Size
Depth Set
Sacks Cement
V. Well Test Data
31
32
33
34
35
36
Date New Oil
Gas Delivery Date
Test Date
Test Length
Tbg. Pressure
Csg. Pressure
37
38
39
40
41
Choke Size
Oil
Water
Gas
Test Method
42
I hereby certify that the rules of the Oil Conservation Division have
OIL CONSERVATION DIVISION
been complied with and that the information given above is true and
complete to the best of my knowledge and belief.
Signature:
Approved by:
Printed name:
Title:
Title:
Approval Date:
E-mail Address:
Date:
Phone:
District I
State of New Mexico
Form C-104
1625 N. French Dr., Hobbs, NM 88240
Revised August 1, 2011
Energy, Minerals & Natural Resources
District II
811 S. First St., Artesia, NM 88210
Submit one copy to appropriate District Office
District III
Oil Conservation Division
1000 Rio Brazos Rd., Aztec, NM 87410
1220 South St. Francis Dr.
AMENDED REPORT
District IV
Santa Fe, NM 87505
1220 S. St. Francis Dr., Santa Fe, NM 87505
I.
REQUEST FOR ALLOWABLE AND AUTHORIZATION TO TRANSPORT
1
2
Operator name and Address
OGRID Number
3
Reason for Filing Code/ Effective Date
4
5
6
API Number
Pool Name
Pool Code
30 - 0
7
8
9
Property Code
Property Name
Well Number
10
II.
Surface Location
Ul or lot no. Section Township Range Lot Idn Feet from the North/South Line Feet from the
East/West line
County
11
Bottom Hole Location
UL or lot no. Section Township Range Lot Idn Feet from the North/South line Feet from the
East/West line
County
12
15
16
17
13
14
Lse Code
Producing Method
Gas Connection
C-129 Permit Number
C-129 Effective Date
C-129 Expiration Date
Code
Date
III. Oil and Gas Transporters
18
19
20
Transporter
Transporter Name
O/G/W
OGRID
and Address
IV. Well Completion Data
21
22
23
24
25
26
Spud Date
Ready Date
TD
PBTD
Perforations
DHC, MC
27
28
29
30
Hole Size
Casing & Tubing Size
Depth Set
Sacks Cement
V. Well Test Data
31
32
33
34
35
36
Date New Oil
Gas Delivery Date
Test Date
Test Length
Tbg. Pressure
Csg. Pressure
37
38
39
40
41
Choke Size
Oil
Water
Gas
Test Method
42
I hereby certify that the rules of the Oil Conservation Division have
OIL CONSERVATION DIVISION
been complied with and that the information given above is true and
complete to the best of my knowledge and belief.
Signature:
Approved by:
Printed name:
Title:
Title:
Approval Date:
E-mail Address:
Date:
Phone: