Form 208 Form 208 Report of Completed and Deepened Wells

Osage Form 208 OMB Control No. 1076-XXXX

Revised May 2013 Expires: XX/XX/XXX

U.S. DEPARTMENT OF THE INTERIOR

BUREAU OF INDIAN AFFAIRS

OSAGE AGENCY

813 Grandview, P.O. Box 1539

Pawhuska, Oklahoma, 74056

(918) 287-5740 FAX: (918) 287-5786

One original must be filed within

10 days after completion of well.

Specify type of well

Oil, Gas, CBM, SWD, Dry, etc._______

REPORT OF COMPLETED & DEEPENED WELLS

WITHIN THE OSAGE RESERVATION

Company operating ____________________________________Address______________________________________________

Lessee_______________________________________________Lessor___Osage Nation_________________________________

Well No.__________ ¼ Sec.__________ Twp. _________ Rge.__________ Farm name___________________________________

Well located _____________ft. from [N] [S] line, __________ [E] [W] line, Elevation GL __________ DF__________ KB_________

Elevation and location surveyed by ____________________________________________________________________________

Drilling contractor(s) _______________________________________ Began__________, 20_____ Finished __________, 20_____

Cable drilled interval and bit size(s) ____________________________________________________________________________

Mud Air Rotary drilled interval & bit size(s)__________________________________________________________________

Casing Record Cementing Contractor___________________________________

Size Wt. Landed at Interval cemented Cement used; include type, gel, additives

_____ins. ______lbs./ft. ________ ft. __________ to ______________ ________________________________________

_____ins. ______lbs./ft. ________ ft. __________ to ______________ ________________________________________

_____ins. ______lbs./ft. ________ ft. __________ to ______________ ________________________________________

Interval(s) perforated ____holes_____________to_____; ____holes_____________to_____; ____holes_____________to_____

Interval(s) left open ____________________________; Interval(s) shut off and method__________________________________

Plug back depth ___________________ Packer set?______________ Setting depth_______________ Packer left in?__________

How were fresh water and other zones protected?________________________________________________________________

Flow Pump Swab Bail Initial 24 hour Production Rate Before Treatment

Casing Tubing Choke size_______ Oil________________ bbls., Gas____________MCF, Water_________bbls

Duration of test ______ hrs., Gravity ____ API FTP ____________psi SICP ___________psi SITP____________psi

Formation treatment (shot, acid, fracture, etc.) Indicate amount of materials used (i.e., nitro, sand, water, acid & other additives) and breakdown pressure.

____________________________________________________________________ _____________ Feet to _____________

____________________________________________________________________ _____________ Feet to _____________

____________________________________________________________________ _____________ Feet to _____________

Flow Pump Swab Bail Initial 24 hour Production Rate Before Treatment

Casing Tubing Choke size_______ Oil________________ bbls., Gas____________MCF, Water_________bbls

Duration of test ______ hrs., Gravity ____ API FTP ____________psi SICP ___________psi SITP____________psi

Location fee paid ___________________________ Date________________________ amount $_________________________

Signature_________________________________________________ Position with Lessee ______________________________

__________ ¼ Sec.__________ Twp. _________ Rge.__________ Datum Elev.______________________________

FORMATION RECORD

Well Number ___________________________________________

FROM	TO	FEET	Note each change in formation, i.e., sand, lime shale, sandy shale, etc. & name key beds. Note character of each formation, i.e., color, hard, soft, caving, etc. Underreamed? Note contents of each formation, i.e., oil, gas, water, and kind of water – fresh, etc.
			(See notes at bottom of page).

Must run and submit open hole logs sufficient to determine resistivity and porosity of all formations. Case hole logs sufficient to correlate with open hole logs and determine cement bond quality. Was well cored ______, enter core description, submit core analysis.

Copies of cementing service tickets should accompany this report. Include drill stem, wire line, etc., test information.