Request for Emergency Test Clearance



Request for Emergency Test ClearanceThis form is to be e-mailed to the Lafayette District Office for approval laf-info@This information below is to be included on the Original Form Completion submitted to the District Office.Date submitting request: FORMTEXT ?????CODES FORMTEXT ?????Parish FORMTEXT ????? FORMTEXT ????Field FORMTEXT ????? FORMTEXT ?????Operator FORMTEXT ????? FORMTEXT ?????Well Name & No: FORMTEXT ?????Serial No: FORMTEXT ?????Reservoir FORMTEXT ?????Completion Date: FORMTEXT ?????Unit Required/Requested: Y FORMCHECKBOX N FORMCHECKBOX Monies Letter:Y FORMCHECKBOX N FORMCHECKBOX Perforations: From FORMTEXT ????? To FORMTEXT ????? Status: FORMTEXT ?????Primary Product:O FORMCHECKBOX G FORMCHECKBOX Clearance & Certification:Additional clearance is requested for FORMTEXT ????? bbls. of oil / FORMTEXT ????? MCF gas produced on Drill-Stem or other production test:----------------------------------------------------------------------------------------------------------------------------------T E S T D A T ADate of TestTime of TestAmount of Oil ProducedAmount of Gas Produced FORMTEXT ????? FORMTEXT ?????M.to FORMTEXT ?????M. FORMTEXT ?????BBLS FORMTEXT ?????MCF FORMTEXT ????? FORMTEXT ?????M.to FORMTEXT ?????M. FORMTEXT ?????BBLS FORMTEXT ?????MCF FORMTEXT ????? FORMTEXT ?????M.to FORMTEXT ?????M. FORMTEXT ?????BBLS FORMTEXT ?????MCF FORMTEXT ????? FORMTEXT ?????M.to FORMTEXT ?????M. FORMTEXT ?????BBLS FORMTEXT ?????MCF FORMTEXT ????? FORMTEXT ?????M.to FORMTEXT ?????M. FORMTEXT ?????BBLS FORMTEXT ?????MCF Total FORMTEXT ????? BBLS Total FORMTEXT ????? MCFTransporter: FORMTEXT ????? Remarks: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????OPERATOR(Signed) Operator RepresentativeRep Tele: FORMTEXT ????? Rep email: FORMTEXT ????? Issued by: EG______ ST_______ District Office emailed Prod Audit: Yes FORMCHECKBOX No FORMCHECKBOX ................
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