INSTRUCTIONS
GENERAL: This form is designed for submitting a complete and correct well completion/recompletion report and log on all types of
wells on Federal and Indian leases to a Federal agency, pursuant to applicable Federal laws and regulations. Any necessary special
instructions concerning the use of this form and the number of copies to be submitted, particularly with regard to local, area, or
regional procedures and practices, either are shown below or will be issued by, or may be obtained from, the local Federal ofce.
If not led prior to the time this summary record is submitted, copies of all currently available logs (drillers, geologists, sample and
core analysis, and all types electric), formation and pressure tests, and directional surveys, should be attached hereto, to the extent required
by applicable Federal laws and regulations. All attachments should be listed on this form, see item 33.
ITEM 4: Locations on Federal or Indian land should be described in accordance with Federal requirements. Consult local Federal
ofce for specic instructions.
ITEM 17: Indicate which reported elevation is used as reference (where not otherwise shown) for depth measurements given in other
spaces on this form and in any attachments.
ITEM 23: Show how reported top(s) of cement were determined, i.e. circulated (CIR), or calculated (CAL), or cement bond log
(CBL), or temperature survey (TS).
NOTICES
The Privacy Act of 1974 and the regulation in 43 CFR 2.48 (d) provide that you be furnished the following information in connection
with information required by this application.
AUTHORITY: 30 U.S.C. 181 et seq., 351 et seq., 25 U.S.C. et seq.; 43 CFR 3160.
PRINCIPAL PURPOSE: The information is to be used to evaluate the actual operations performed in the drilling, completing and
testing of a well on a Federal or Indian lease.
ROUTINE USES: (1) Evaluate the equipment and procedures used during the drilling and completing/recompleting of a well. (2) The
review of geologic zones and formation encountered during drilling. (3) Analyze future applications to drill in light of data obtained
and methods used. (4)(5) Information from the record and/or the record will be transferred to appropriate Federal, State, local or
foreign agencies, when relevant to civil, criminal or regulatory investigations or prosecutions.
EFFECT OF NOT PROVIDING INFORMATION: Filing of this report and disclosure of the information is mandatory once a well
drilled on a Federal or Indian lease is completed/recompleted.
The Paperwork Reduction Act of 1995 requires us to inform you that:
The BLM collects this information to allow evaluation of the technical, safety, and environmental factors involved with drilling and
completing/recompleting wells on Federal and Indian oil and gas leases.
This information will be used to analyze operations and to compare equipment and procedures actually used with those proposed and
approved.
Response to this request is mandatory only if the operator elects to initiate drilling and completing/recompleting operations on an oil
and gas lease.
The BLM would like you to know that you do not have to respond to this or any other Federal agency-sponsored information
collection unless it displays a currently valid OMB control number.
BURDEN HOURS STATEMENT: Public reporting burden for this form is estimated to average 8 hours per response, including
the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments
regarding the burden estimate or any other aspect of this form to U.S. Department of the Interior, Bureau of Land Management
(1004-0137), Bureau Information Collection Clearance Ofcer (WO-630), 1849 C Street, N.W., Mail Stop 401 LS, Washington, D.C.
20240.
(Form 3160-4, page 3)
