Form C-108 "Application for Authorization to Inject" - New Mexico

What Is Form C-108?

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. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 10, 2003;
  • The latest edition provided by the New Mexico Energy, Minerals and Natural Resources Department;
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  • Fill out the form in our online filing application.

Download a printable version of Form C-108 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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STATE OF NEW MEXICO
Oil Conservation Division
FORM C-108
ENERGY, MINERALS AND NATURAL
1220 South St. Francis Dr.
Revised June 10, 2003
RESOURCES DEPARTMENT
Santa Fe, New Mexico 87505
APPLICATION FOR AUTHORIZATION TO INJECT
I.
PURPOSE:
__________Secondary Recovery
_________Pressure Maintenance
_________Disposal
_________Storage
Application qualifies for administrative approval?
__________Yes
__________No
II.
OPERATOR: _____________________________________________________________________________________________
ADDRESS: ______________________________________________________________________________________________
CONTACT PARTY: _______________________________________________________________PHONE: ________________
III.
WELL DATA: Complete the data required on the reverse side of this form for each well proposed for injection.
Additional sheets may be attached if necessary.
IV.
Is this an expansion of an existing project?
__________Yes
__________No
If yes, give the Division order number authorizing the project: ______________________________________________________
V.
Attach a map that identifies all wells and leases within two miles of any proposed injection well with a one-half mile radius circle
drawn around each proposed injection well. This circle identifies the well's area of review.
VI.
Attach a tabulation of data on all wells of public record within the area of review which penetrate the proposed injection zone. Such
data shall include a description of each well's type, construction, date drilled, location, depth, record of completion, and a schematic
of any plugged well illustrating all plugging detail.
VII.
Attach data on the proposed operation, including:
1. Proposed average and maximum daily rate and volume of fluids to be injected;
2. Whether the system is open or closed;
3. Proposed average and maximum injection pressure;
4. Sources and an appropriate analysis of injection fluid and compatibility with the receiving formation if other than reinjected
produced water; and,
5. If injection is for disposal purposes into a zone not productive of oil or gas at or within one mile of the proposed well, attach a
chemical analysis of the disposal zone formation water (may be measured or inferred from existing literature, studies, nearby
wells, etc.).
*VIII. Attach appropriate geologic data on the injection zone including appropriate lithologic detail, geologic name, thickness, and depth.
Give the geologic name, and depth to bottom of all underground sources of drinking water (aquifers containing waters with total
dissolved solids concentrations of 10,000 mg/l or less) overlying the proposed injection zone as well as any such sources known to
be immediately underlying the injection interval.
IX.
Describe the proposed stimulation program, if any.
*X.
Attach appropriate logging and test data on the well. (If well logs have been filed with the Division, they need not be resubmitted).
*XI. Attach a chemical analysis of fresh water from two or more fresh water wells (if available and producing) within one mile of any
injection or disposal well showing location of wells and dates samples were taken.
XII.
Applicants for disposal wells must make an affirmative statement that they have examined available geologic and engineering data
and find no evidence of open faults or any other hydrologic connection between the disposal zone and any underground sources of
drinking water.
XIII. Applicants must complete the "Proof of Notice" section on the reverse side of this form.
XIV. Certification: I hereby certify that the information submitted with this application is true and correct to the best of my knowledge and
belief.
NAME: __________________________________________________________TITLE: _________________________________
SIGNATURE: ___________________________________________________________DATE: __________________________
E-MAIL ADDRESS: ______________________________________________________
*
If the information required under Sections VI, VIII, X, and XI above has been previously submitted, it need not be resubmitted.
Please show the date and circumstances of the earlier submittal: _____________________________________________________
DISTRIBUTION: Original and one copy to Santa Fe with one copy to the appropriate District Office
STATE OF NEW MEXICO
Oil Conservation Division
FORM C-108
ENERGY, MINERALS AND NATURAL
1220 South St. Francis Dr.
Revised June 10, 2003
RESOURCES DEPARTMENT
Santa Fe, New Mexico 87505
APPLICATION FOR AUTHORIZATION TO INJECT
I.
PURPOSE:
__________Secondary Recovery
_________Pressure Maintenance
_________Disposal
_________Storage
Application qualifies for administrative approval?
__________Yes
__________No
II.
OPERATOR: _____________________________________________________________________________________________
ADDRESS: ______________________________________________________________________________________________
CONTACT PARTY: _______________________________________________________________PHONE: ________________
III.
WELL DATA: Complete the data required on the reverse side of this form for each well proposed for injection.
Additional sheets may be attached if necessary.
IV.
Is this an expansion of an existing project?
__________Yes
__________No
If yes, give the Division order number authorizing the project: ______________________________________________________
V.
Attach a map that identifies all wells and leases within two miles of any proposed injection well with a one-half mile radius circle
drawn around each proposed injection well. This circle identifies the well's area of review.
VI.
Attach a tabulation of data on all wells of public record within the area of review which penetrate the proposed injection zone. Such
data shall include a description of each well's type, construction, date drilled, location, depth, record of completion, and a schematic
of any plugged well illustrating all plugging detail.
VII.
Attach data on the proposed operation, including:
1. Proposed average and maximum daily rate and volume of fluids to be injected;
2. Whether the system is open or closed;
3. Proposed average and maximum injection pressure;
4. Sources and an appropriate analysis of injection fluid and compatibility with the receiving formation if other than reinjected
produced water; and,
5. If injection is for disposal purposes into a zone not productive of oil or gas at or within one mile of the proposed well, attach a
chemical analysis of the disposal zone formation water (may be measured or inferred from existing literature, studies, nearby
wells, etc.).
*VIII. Attach appropriate geologic data on the injection zone including appropriate lithologic detail, geologic name, thickness, and depth.
Give the geologic name, and depth to bottom of all underground sources of drinking water (aquifers containing waters with total
dissolved solids concentrations of 10,000 mg/l or less) overlying the proposed injection zone as well as any such sources known to
be immediately underlying the injection interval.
IX.
Describe the proposed stimulation program, if any.
*X.
Attach appropriate logging and test data on the well. (If well logs have been filed with the Division, they need not be resubmitted).
*XI. Attach a chemical analysis of fresh water from two or more fresh water wells (if available and producing) within one mile of any
injection or disposal well showing location of wells and dates samples were taken.
XII.
Applicants for disposal wells must make an affirmative statement that they have examined available geologic and engineering data
and find no evidence of open faults or any other hydrologic connection between the disposal zone and any underground sources of
drinking water.
XIII. Applicants must complete the "Proof of Notice" section on the reverse side of this form.
XIV. Certification: I hereby certify that the information submitted with this application is true and correct to the best of my knowledge and
belief.
NAME: __________________________________________________________TITLE: _________________________________
SIGNATURE: ___________________________________________________________DATE: __________________________
E-MAIL ADDRESS: ______________________________________________________
*
If the information required under Sections VI, VIII, X, and XI above has been previously submitted, it need not be resubmitted.
Please show the date and circumstances of the earlier submittal: _____________________________________________________
DISTRIBUTION: Original and one copy to Santa Fe with one copy to the appropriate District Office
Side 2
III. WELL DATA
A.
The following well data must be submitted for each injection well covered by this application. The data must be both in tabular and
schematic form and shall include:
(1) Lease name; Well No.; Location by Section, Township and Range; and footage location within the section.
(2) Each casing string used with its size, setting depth, sacks of cement used, hole size, top of cement, and how such top was
determined.
(3) A description of the tubing to be used including its size, lining material, and setting depth.
(4) The name, model, and setting depth of the packer used or a description of any other seal system or assembly used.
Division District Offices have supplies of Well Data Sheets which may be used or which may be used as models for this purpose.
Applicants for several identical wells may submit a "typical data sheet" rather than submitting the data for each well.
B.
The following must be submitted for each injection well covered by this application. All items must be addressed for the initial well.
Responses for additional wells need be shown only when different. Information shown on schematics need not be repeated.
(1) The name of the injection formation and, if applicable, the field or pool name.
(2) The injection interval and whether it is perforated or open-hole.
(3) State if the well was drilled for injection or, if not, the original purpose of the well.
(4) Give the depths of any other perforated intervals and detail on the sacks of cement or bridge plugs used to seal off such
perforations.
(5) Give the depth to and the name of the next higher and next lower oil or gas zone in the area of the well, if any.
XIV. PROOF OF NOTICE
All applicants must furnish proof that a copy of the application has been furnished, by certified or registered mail, to the owner of the
surface of the land on which the well is to be located and to each leasehold operator within one-half mile of the well location.
Where an application is subject to administrative approval, a proof of publication must be submitted. Such proof shall consist of a
copy of the legal advertisement which was published in the county in which the well is located. The contents of such advertisement
must include:
(1) The name, address, phone number, and contact party for the applicant;
(2) The intended purpose of the injection well; with the exact location of single wells or the Section,
Township, and Range location of multiple wells;
(3) The formation name and depth with expected maximum injection rates and pressures; and,
(4) A notation that interested parties must file objections or requests for hearing with the Oil Conservation Division, 1220 South St.
Francis Dr., Santa Fe, New Mexico 87505, within 15 days.
NO ACTION WILL BE TAKEN ON THE APPLICATION UNTIL PROPER PROOF OF NOTICE HAS BEEN SUBMITTED.
NOTICE: Surface owners or offset operators must file any objections or requests for hearing of administrative applications within 15 days
from the date this application was mailed to them.
INJECTION WELL DATA SHEET
Side 1
OPERATOR: ______________________________________________________________________________________________________________
WELL NAME & NUMBER: __________________________________________________________________________________________________
WELL LOCATION: _________________________________________________________________________________________________________
FOOTAGE LOCATION
UNIT LETTER
SECTION
TOWNSHIP
RANGE
WELLBORE SCHEMATIC
WELL CONSTRUCTION DATA
Surface Casing
Hole Size: ________________________
Casing Size:____________________
3
Cemented with: _________________ sx.
or _________________________ ft
Top of Cement: ____________________
Method Determined: _____________
Intermediate Casing
Hole Size: ________________________
Casing Size:____________________
3
Cemented with: _________________ sx.
or _________________________ ft
Top of Cement: ____________________
Method Determined: _____________
Production Casing
Hole Size: ________________________
Casing Size:____________________
3
Cemented with: _________________ sx.
or _________________________ ft
Top of Cement: ____________________
Method Determined: _____________
Total Depth: ______________________
Injection Interval
______________________________feet to____________________________
(Perforated or Open Hole; indicate which)
Side 2
INJECTION WELL DATA SHEET
Tubing Size: _____________________________Lining Material: _____________________________
Type
of Packer: _____________________________________________________________________
Packer Setting Depth: ______________________
Other Type of Tubing/Casing Seal (if applicable): __________________________________________
Additional Data
1.
Is this a new well drilled for injection?
_______Yes _______No
If no, for what purpose was the well originally drilled? __________________________________
______________________________________________________________________________
2.
Name of the Injection Formation: ___________________________________________________
3.
Name of Field or Pool (if applicable): ________________________________________________
4.
Has the well ever been perforated in any other zone(s)? List all such perforated
intervals and give plugging detail, i.e. sacks of cement or plug(s) used. _____________________
______________________________________________________________________________
5.
Give the name and depths of any oil or gas zones underlying or overlying the proposed
injection zone in this area: ________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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