H_form7_page1 2467 03 Form7
User Manual: 2467-03
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Page Count: 3
Amount PulledCasing Size (Inches)
Acid, Frac, Sqz, Etc.Swab/Prod. Potential (Oil/Water)
Well Name and Number
PLEASE READ INSTRUCTIONS BEFORE FILLING OUT FORM.
PLEASE SUBMIT THE ORIGINAL AND ONE COPY.
Operator Telephone Number
Amount and Kind of Material Used
Drilling Contractor and Rig Number Plugging Contractor(s)
Sacks Cement Top of Cement
PLUGGING RECORD
BISMARCK, ND 58505-0840
SFN 2467 (03-2004)
Well File No.
PLUGGING REPORT - FORM 7
INDUSTRIAL COMMISSION OF NORTH DAKOTA
OIL AND GAS DIVISION
600 EAST BOULEVARD DEPT 405
Address Field
City State Zip Code Deepest Pool Penetrated
Section TownshipAt Surface Qtr-Qtr
LOCATION
FLF
MD
L
Type of Electric and Other Logs Run (See Instructions)
FL
No
N
Spud Date KB ElevationDate TD Reached
Weight of Fluid Between Plugs (Lbs/Gal) Name of Field Inspector Present During Plugging
TD (Feet) No. of DSTs
Was Well Cored?
TVD Yes
Directional Survey Run?
Date Well Plugged
List Intervals:
No
(See Back)
Yes
Hole Size (Inches) Weight (Lbs/Ft)
CASING RECORD (Report all strings set in well)
Measured Depth Set (Feet)
Perforations
ATTEMPTED COMPLETION DATA (If not previously reported)
Holes Per Foot
Type of Plug Interval/Depth Formation Isolated Sacks of Cement/Class
F
County
W
Range
L
Qtr-Qtr CountyRangeBottom Hole Location Section Township
N
W
Page 2
SFN 2467 (03-2004)
Signature Printed Name
Above Signature Witnessed By
Witness Signature Witness Printed Name Witness Title
Title
DRILL STEM TEST DATA (IF NOT PREVIOUSLY REPORTED), ADDITIONAL INFORMATION, AND/OR LIST OF ATTACHMENTS
Date
I hereby swear or affirm that the information provided is true, complete and correct as determined from all available records.
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.
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.
PLUGGING REPORT - FORM 7
SFN 2467
survey contractor.
6. Two copies of any directional surveys run shall be filed directly with the Commission by the
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.
