Fillable Form 3260-5: DEPARTMENT OF THE INTERIOR OMB NO. (Bureau of Land Management - Main Domain)

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Form 3260-5: DEPARTMENT OF THE INTERIOR OMB NO. (Bureau of Land Management - Main Domain)

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MONTHLY REPORT OF GEOTHERMAL OPERATIONS
UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
FORM APPROVED
OMB
NO. 1004-0132
Expires: February 29, 2020
Form 3260-5
(April 2019)
The Bureau of Land Management (BLM) requires this form or other BLM approval forms
(computerized, company, State, etc.) to be prepared for each month beginning with the month in
which drilling is initiated and filed in duplicate with the BLM, on or before the last day
of the month
following unless exception is granted by the BLM.
3. Lease Serial No.
4. Surface Manager:
BLM FS Other
The following is a complete and accurate report of all operations and production for the Month
of
_______________________, 20______ .
5. Unit Agreement Name
Signed:
____________________________ Title: _________________________ Date: _______________
6. Field or Area
1. Name of Lessee/Operator
7. County
2. Address of Lessee/Operator
8.
State
9.
INDIVIDUAL WELL PRODUCTION
MONTHLY PRODUCTION OR INJECTION
PRODUCTION OR INJECTION RATE
AVERAGE
TEMPERATURE PRESSURE
psi
TWSP, RGE
SEC., B&M
WELL
NUMBER
TYPE
(S TATUS)
DAYS
PROD.
OR INJ.
TOTAL
(lb)
STEAM
(lb)
WATER
(lb)
TOTAL
(lb)
STEAM
(lb)
WATER
(lb)
IN
°F
OUT
°F
(Continued on page 2)
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SPECIFIC INSTRUCTIONS
10. OPERATIONS CONDUCTED DURING MONTH: Describe Drilling, Remedial Drilling, Redrilling, Stimulation, Testing and other Well Work Performed.
TWSP, RGE, SEC.,
B&M
WELL NUMBER OPERATIONS CONDUCTED MONTH END STATUS
Remarks: (use additional pages if needed)
GENERAL INSTRUCTIONS
This form is designed for submitting a complete and accurate account of monthly activity and performance of geothermal wells and production facilities on Federal leases. The report must include
wells on the lease that have not been abandoned.
Item 9: Group wells together that are producing or injecting into the same reservoir or zone, and
distinguish reservoirs or zones by name such as uppe r, lower, formation name, etc. Within each zone,
list injection wells separately from production wells. In column 3, show the type of well reported
(P=production, I=injection,
1
D=disposal,
2
, WS=water supply, OB=observation, HE=heat exchange,
O=other (specify under remarks) and in parenthesi s the current month end status for each well or
completion (i=injecting, f=flowing, p=pumping, si=shut-in, susp=sus pended, obs=observation, o=other
(specify under remarks)). For heat exchange wells, report production in British thermal units, Btu, and
production rate in Btu/hr. Production or injection rate is
the total amount of mass flow divided by the total
number of active well hours.
Item 10: In reporting current operations, particular attention should be directed to 43 CFR
3264.2-4(e).
Remarks: Report in this section any environmental monitoring conducted and the results obtained.
1
An injection well is used for injection of fluids that are not produced from the formation or
reservoir.
2
A disposal well is used to inject fluids into the same formation or reservoir from which they are
produced.
Title 18 U.S.C. Section 1001, makes it a crime for any person knowingly and willfully to make to any department or agency of the United States any false, fictitious or fraudulent statements or representations as to any matter
within jurisdiction.
(Continued on page 3) (Form 3260-5, page 2)
EFFECT OF NOT PROVIDING INFORMATION: Disclosure of the information is required for compliance with pertinent statutes and regulations.
If all the information is not provided, the BLM may direct you to take corrective action within a specific time period.
The Paperwork Reduction Act (44 U.S.C. 3501-3521) requires that we provide you with the following information:
The BLM uses this information to evaluate the technical, safety, and environmental factors involved with geothermal resources on Federal geothermal
leases.
Response to this request is required to obtain or retain a benefit.
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.
NOTICES
The Privacy Act (5 U.S.C. 552a) and 43 CFR 2.48(d) require that we provide you with the following information:
AUTHORITY: 30 U.S.C. 1001-1028; 43 CFR Part 3200.
PRINCIPAL PURPOSE: The BLM uses this information to evaluate the technical, safety, and environmental factors involved with geothermal
resources on Federal geothermal leases.
ROUTINE USES: (1) The adjudication of the form. (2) Documentation for public information in support of notations made on land status, records for
the management, disposal, and use of public lands and resources. (3) Transfer to appropriate Federal agencies when concurrence is required prior to
granting a right in public lands or resources. (4) 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.
BURDEN HOURS STATEMENT: The public reporting burden for this form is estimated to average 10 hours per response, including the time for
reviewing instructions, gathering and maintaining data, and completing and reviewing the form. You may send direct comments regarding the burden
estimate or any other aspect of this form to the U.S. Department of the Interior, Bureau of Land Management (1004-0132), Bureau Information
Collection Clearance Officer (WO-630), 1849 C Street, N.W., Washington, D.C. 20240.
(Form 3260-5, page 3)
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Form 3260-5: DEPARTMENT OF THE INTERIOR OMB NO. (Bureau of Land Management - Main Domain)

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Completed 19 July 2020

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