FORM 1022A – VACUUM PUMP USE APPLICATION

FORM 1022A – VACUUM PUMP USE APPLICATION

This presentation will assist you in the completion of the Form 1022A. The vacuum use application.

Date of Last Revision: 2002

Rule Requirement: 10-3-31

Explanation of Form: Operator shall file one copy of Form 1022A with the required attachments with the Technical Services Department of the Conservation Division. [Reference 165:10-3-31]

Question concerning this Form: For more information contact Geology Department at (405) 521-6044.

FORM 1022A – VACUUM PUMP USE APPLICATION

TYPE OF APPLICATION – WELL or LEASE

FORM 1022A – VACUUM PUMP USE APPLICATION

CD NUMBER – This item is not needed unless the use is protested and is referred to Administrative Law.

FORM 1022A – VACUUM PUMP USE APPLICATION

NAME OF OPERATOR

FORM 1022A – VACUUM PUMP USE APPLICATION

OTC/OCC OPERATOR NUMBER

FORM 1022A – VACUUM PUMP USE APPLICATION

MAILING ADDRESS, PHONE NUMBER, CITY, STATE, ZIP CODE AND FAX NUMBER

FORM 1022A – VACUUM PUMP USE APPLICATION

LEASE NAME / NUMBER

FORM 1022A – VACUUM PUMP USE APPLICATION

NUMBER OF WELLS ON LEASE

FORM 1022A – VACUUM PUMP USE APPLICATION

LOCATION WITHIN THE SECTION, SECTION, TOWNSHIP AND RANGE ALONG WITH THE COUNTY WHERE THE WELLS ARE LOCATED

FORM 1022A – VACUUM PUMP USE APPLICATION

API NUMBER

FORM 1022A – VACUUM PUMP USE APPLICATION

OTC LEASE NUMBER

FORM 1022A – VACUUM PUMP USE APPLICATION

COMPLETION DATE

FORM 1022A – VACUUM PUMP USE APPLICATION

TOP OF PAY AVERAGE DEPTH

FORM 1022A – VACUUM PUMP USE APPLICATION

PRODUCING FORMATION(S)

FORM 1022A – VACUUM PUMP USE APPLICATION

DATE OF LAST TEST – - Oil (In Barrels) - Water (In Barrels) - Gas (In MCF)

FORM 1022A – VACUUM PUMP USE APPLICATION

AVERAGE TEST (IF LEASE APPLICATION) - Oil (In Barrels) - Water (In Barrels) - Gas (In MCF)

FORM 1022A – VACUUM PUMP USE APPLICATION

VACUUM APPLIED FOR – (Indicate if measured in PSIG or Inches of Mercury)

FORM 1022A – VACUUM PUMP USE APPLICATION

VACUUM BEING PULLED _______ INCHES OF MERCURY

FORM 1022A – VACUUM PUMP USE APPLICATION

ESTIMATED INCREASE IN PRODUCTION - Oil (In Barrels) - Water (In Barrels) - Gas (In MCF)

FORM 1022A – VACUUM PUMP USE APPLICATION

PLANNED DISPOSITION OF GAS – CHECK ONE - Sale - Flare - Vent - Fuel

Permit Number

FORM 1022A – VACUUM PUMP USE APPLICATION

NUMBER OF WELLS WITHIN 1 MILE RADIUS ON VACCUM

FORM 1022A – VACUUM PUMP USE APPLICATION

HAVE OFFSET OPERATORS BEEN NOTIFIED OF THIS APPLICATION? Do not make application unless this item has been completed.

FORM 1022A – VACUUM PUMP USE APPLICATION

REQUIRED DATA – These items must be attached to this application or it cannot be processed.

FORM 1022A – VACUUM PUMP USE APPLICATION

OPERATOR’S SIGNATURE BLOCK

FORM 1022A – VACUUM PUMP USE APPLICATION

FOR OCC USE ONLY – Do Not Write Below this Line