Instructions for Form 204 - Annual Report

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OHIO DEPARTMENT OF NATURAL RESOURCES
DIVISION OF OIL & GAS RESOURCES MANAGEMENT
2045 Morse Road, F-2 • Columbus, OH 43229-6693
(614) 265-6922
Annual Report (Form 204) – Instructions
Per Ohio Administrative Code paragraph
1501:9-3-07(E)
and 1501:9-3-07(F), monitoring data must submitted on the Annual
th
Report form (Form 204) supplied by the Division of Oil and Gas Resources Management (Division) no later than April 15
for
the preceding calendar year. This is available for download on the Division’s website at
http://oilandgas.ohiodnr.gov/electronicforms. All information requested on Form 204 must be provided unless exempted by
the instructions below. Outdated or deficient forms will not be processed by the Division and will be returned to the
sender.
➢ For Calendar Year – Enter the calendar year the report is for.
1. Owner Number – Enter the owner number of the owner of the well. This number is issued after completion of the
Authority & Organization Form (Form 9).
2. Owner Name, Address, and Telephone – Enter the owner name, address and contact information. If this information
is not up to date with the Division, complete and submit an Authority & Organization Form (Form 9) with the updated
information.
3. API Number – Enter the American Petroleum Institute (API) number issued for the well. This is the 14 digit number
which appears at the top of the permit, formatted as: 34-###-2-####-0000.
4. Lease Name – Enter the lease name of the well as it appears on the permit. The lease number as it appears on the
permit may be entered here as well.
5. SWIW or ERP number – Enter the SWIW or ERP number issued by the Division on the well permit. This number is
usually located in the well name on the permit enclosed in brackets or parentheses.
6. County – Enter the county name as it appears on the permit.
7. Civil Township – Enter the township name as it appears on the permit.
8. Type of Well – Indicate the type of well by checking the appropriate box. If other, then specify the well type.
9. Type of Fluid – Indicate the type(s) of fluid injected. For Enhanced Recovery Projects, if gas or other, then specify
fluid type.
10. Injection Pressure (PSI) and Volume (BBL or MCF) – For each month enter the number of days in operation, the total
volume injected, the maximum injection pressure reached, and the average daily injection pressure. This section must
be filled out even if the well was not used. If the well is on vacuum, write down “vacuum” in the appropriate injection
pressure columns.
11. Annulus Pressure – Complete section A if the well was permitted after 10/1/2012. If permitted before 10/1/2012,
complete section A if the pressure in the annulus behind the injection tubing is continuously monitored, or complete
section B if the annulus is pressure tested monthly. Do not enter any injection pressures in this section. Only enter
annulus pressure. This section must be completed even if the well was not used during the reporting period.
a. Section A – If continuously monitored, enter the monthly maximum and minimum annulus pressures and the
dates that each pressure was reached.
b. Section B – If pressure tested monthly, record the annular pressure at the beginning of the test, at least 200
psi, and the annular pressure at the end of the test, at least 15 minutes.
12. MIT Results – Disclose the results of any mechanical integrity tests that were conducted on this well during the
reporting period. Attach any documentation to the form when it is submitted. If there are other reporting
requirements, note the requirement in this section or section 13 and attach any documentation.
13. Failures and Corrective action – Disclose all mechanical failures, corrective actions and results of those actions within
the reporting period. If there are other reporting requirements, note the requirement in this section or section 12
and attach any documentation.
14. Name, Title, Signature and Date – Print full name and title with the company. Sign and date the report.
Updated 2/2018
OHIO DEPARTMENT OF NATURAL RESOURCES
DIVISION OF OIL & GAS RESOURCES MANAGEMENT
2045 Morse Road, F-2 • Columbus, OH 43229-6693
(614) 265-6922
Annual Report (Form 204) – Instructions
Per Ohio Administrative Code paragraph
1501:9-3-07(E)
and 1501:9-3-07(F), monitoring data must submitted on the Annual
th
Report form (Form 204) supplied by the Division of Oil and Gas Resources Management (Division) no later than April 15
for
the preceding calendar year. This is available for download on the Division’s website at
http://oilandgas.ohiodnr.gov/electronicforms. All information requested on Form 204 must be provided unless exempted by
the instructions below. Outdated or deficient forms will not be processed by the Division and will be returned to the
sender.
➢ For Calendar Year – Enter the calendar year the report is for.
1. Owner Number – Enter the owner number of the owner of the well. This number is issued after completion of the
Authority & Organization Form (Form 9).
2. Owner Name, Address, and Telephone – Enter the owner name, address and contact information. If this information
is not up to date with the Division, complete and submit an Authority & Organization Form (Form 9) with the updated
information.
3. API Number – Enter the American Petroleum Institute (API) number issued for the well. This is the 14 digit number
which appears at the top of the permit, formatted as: 34-###-2-####-0000.
4. Lease Name – Enter the lease name of the well as it appears on the permit. The lease number as it appears on the
permit may be entered here as well.
5. SWIW or ERP number – Enter the SWIW or ERP number issued by the Division on the well permit. This number is
usually located in the well name on the permit enclosed in brackets or parentheses.
6. County – Enter the county name as it appears on the permit.
7. Civil Township – Enter the township name as it appears on the permit.
8. Type of Well – Indicate the type of well by checking the appropriate box. If other, then specify the well type.
9. Type of Fluid – Indicate the type(s) of fluid injected. For Enhanced Recovery Projects, if gas or other, then specify
fluid type.
10. Injection Pressure (PSI) and Volume (BBL or MCF) – For each month enter the number of days in operation, the total
volume injected, the maximum injection pressure reached, and the average daily injection pressure. This section must
be filled out even if the well was not used. If the well is on vacuum, write down “vacuum” in the appropriate injection
pressure columns.
11. Annulus Pressure – Complete section A if the well was permitted after 10/1/2012. If permitted before 10/1/2012,
complete section A if the pressure in the annulus behind the injection tubing is continuously monitored, or complete
section B if the annulus is pressure tested monthly. Do not enter any injection pressures in this section. Only enter
annulus pressure. This section must be completed even if the well was not used during the reporting period.
a. Section A – If continuously monitored, enter the monthly maximum and minimum annulus pressures and the
dates that each pressure was reached.
b. Section B – If pressure tested monthly, record the annular pressure at the beginning of the test, at least 200
psi, and the annular pressure at the end of the test, at least 15 minutes.
12. MIT Results – Disclose the results of any mechanical integrity tests that were conducted on this well during the
reporting period. Attach any documentation to the form when it is submitted. If there are other reporting
requirements, note the requirement in this section or section 13 and attach any documentation.
13. Failures and Corrective action – Disclose all mechanical failures, corrective actions and results of those actions within
the reporting period. If there are other reporting requirements, note the requirement in this section or section 12
and attach any documentation.
14. Name, Title, Signature and Date – Print full name and title with the company. Sign and date the report.
Updated 2/2018

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