H_form7_page1 2467 03 Form7

User Manual: 2467-03

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PLUGGING REPORT - FORM 7
INDUSTRIAL COMMISSION OF NORTH DAKOTA
OIL AND GAS DIVISION
600 EAST BOULEVARD DEPT 405
BISMARCK, ND 58505-0840

Well File No.

SFN 2467 (03-2004)

PLEASE READ INSTRUCTIONS BEFORE FILLING OUT FORM.
PLEASE SUBMIT THE ORIGINAL AND ONE COPY.
Operator

Telephone Number

Well Name and Number

Address

Field

City

State

Zip Code

Deepest Pool Penetrated

LOCATION
At Surface

Qtr-Qtr

F

L

F

L

L

F

L

Spud Date

Qtr-Qtr
Date TD Reached

Township

Section

Township

TD (Feet)

County

W
Range

N

KB Elevation

County

W
No. of DSTs

MD

Directional Survey Run?

TVD (See Back)

Was Well Cored?

Type of Electric and Other Logs Run (See Instructions)

Range

N

Bottom Hole Location
F

Section

No

No

Yes

Yes

List Intervals:
Weight of Fluid Between Plugs (Lbs/Gal)
Date Well Plugged

Name of Field Inspector Present During Plugging

Drilling Contractor and Rig Number

Plugging Contractor(s)

CASING RECORD (Report all strings set in well)
Casing Size (Inches) Measured Depth Set (Feet)

Amount Pulled

Hole Size (Inches)

Weight (Lbs/Ft)

Sacks Cement

Top of Cement

ATTEMPTED COMPLETION DATA (If not previously reported)
Perforations

Holes Per Foot Swab/Prod. Potential (Oil/Water) Acid, Frac, Sqz, Etc.

Amount and Kind of Material Used

PLUGGING RECORD
Type of Plug

Interval/Depth

Formation Isolated

Sacks of Cement/Class

Page 2
SFN 2467 (03-2004)

DRILL STEM TEST DATA (IF NOT PREVIOUSLY REPORTED), ADDITIONAL INFORMATION, AND/OR LIST OF ATTACHMENTS

I hereby swear or affirm that the information provided is true, complete and correct as determined from all available records.
Signature

Printed Name

Title

Above Signature Witnessed By
Witness Signature

Witness Printed Name

Witness Title

Date

PLUGGING REPORT - FORM 7
SFN 2467

1. This report shall be filed by the operator with the Commission within thirty (30) days after the
plugging of any well. Please refer to Sections 43-02-03-07, 43-02-03-31, and 43-02-03-33 of the
North Dakota Administrative Code.
2. The well file number, operator, well name and number, field, pool, well location(s), and any other
pertinent data shall coincide with the official records on file with the Commission. If it does not,
an explanation shall be given.
3. If a parasite string was used in the drilling of a well, the size, depth set, cement volume used to
plug, and the date plugged shall be included. This information may be included in the "Additional
Information" portion of the report or included as an attachment.
4. On horizontal or directional wells, the following information shall be included if applicable: pilot
hole total depth, kick-off point, original lateral total depth, and all sidetracked interval starting and
ending footages. This information may be included in the "Additional Information" portion of the
report or included as an attachment.
5. The operator shall file with the Commission two copies of all logs run. Logs shall be
submitted as one paper copy and one digital LAS (log ASCII) formatted copy, or a
format approved by the Director. In addition, operators shall file two copies of the
following: drill stem test reports and charts, core analyses, formation water analyses and
noninterpretive lithologic logs or sample descriptions if compiled.
6. Two copies of any directional surveys run shall be filed directly with the Commission by the
survey contractor.
7. The original and one copy of this report shall be filed with the Industrial Commission of North
Dakota, Oil and Gas Division, 600 East Boulevard, Dept. 405, Bismarck, ND 58505-0840.
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