1800 Washingn Blvd. Baltimore Maryland 21230 OIL/GAS WELL COMPLETION REPORT Permit No. Name of Operar Address Well Name and Number Surveyed elevation (feet): KB GL Well Location Field (If wildcat, so state) Pool County Drilling contracr Date spudded Date drilling reached tal depth Total depth: driller logger plugback Total depth in sidetracked hole (STH): driller logger plugback Kick-off point: direction @ depth of Resultant lateral direction Botm hole location CASING AND LINER RECORD Casing type Size Used in drilling Left in hole Depth set below: KB GL r Page 1 of 5
1800 Washingn Blvd. Baltimore Maryland 21230 CEMENT RECORD Size of Interval No. sacks Type Service hole cemented Date of cement cement Test Pressure Company SQUEEZE CEMENT RECORD Interval No. Sacks Type Service squeezed Date of Cement Cement Company PERFORATION RECORD Perforation Service interval Date Holes/ft. Size & Type Company r Page 2 of 5
1800 Washingn Blvd. Baltimore Maryland 21230 TUBING RECORD Size Name & Type Depth set MECHANICAL PLUG AND PACKER RECORD Size Weight range Name & type Depthset Date Test Pressure WELL STIMULATION AND TREATMENT RECORD Service Process Interval Date Material & Quantity Pressure Company DRILL STEM TEST RECORD Test date Interval Type and volume of fluids recovered (oil, gas, water, etc.) Page 3 of 5
1800 Washingn Blvd. Baltimore Maryland 21230 GEOPHYSICAL LOG RECORD Interval logged: maximum depth Interval logged STH: maximum depth minimum depth minimum depth If well not logged tal depth explain why: Log types: induction, resistivity, sonic, neutron, density, gamma ray, dipmeter, directional, bond, flowmeter, temperature, radioactive tracer, etc. including computer generated logs. Type Date run Interval logged From feet From feet From feet From feet From feet From feet From feet CORE RECORD Cored: from feet; recovered feet feet; recovered feet feet; recovered feet feet; recovered feet Were sidewall cores taken: yes no If yes complete the following: Number taken: from feet SAMPLE RECORD Samples collected: from feet; recovered feet and from feet; recovered feet and from feet; recovered feet Page 4 of 5
1800 Washingn Blvd. Baltimore Maryland 21230 GEOLOGICAL LOG Geologic formation Top Botm Gas at Oil at Water at Remarks This completion report is true and correct the best of my knowledge. Date Signature Company This Notice is provided pursuant 10-624 of the State Government Article of the Maryland Code. The personal information requested on this form is intended be used in processing your application. Failure provide the information requested may result in your application not being processed. You have the right inspect, amend, or correct this form. The Maryland Department of the Environment ( MDE ) is a public agency and subject the Maryland Public Information Act (Md. Code Ann., State Gov't 10-601, et seq.). This form may be made available on the Internet via MDE s website and is subject inspection or copying, in whole or in part, by the public and other governmental agencies, if not protected by federal or State law. Page 5 of 5