| Form 21 |  Related  Doc |
| Date Submitted: | 7/8/2003 | MIT Assigned By: | ADKINS, JAIME |
| Date Recv'd: | 2/3/2004 | Facility ID: | 150200 |
| DocNum: | 1241682 | Facility Status: | AC |
| Operator Information: |
| Oper. No. | 16700 |
| Operator: | CHEVRON U S A INC |
| Address: | 100 CHEVRON RD RANGELY CO 81648 |
| Type Of Facility: | UIC ENHANCED RECOVERY | Well Status: AC |
| Facility Name | FEE |
| Operator contact: | DIANE PETERSON |
| Location: | | qtrqtr: SENE | section: 16 | township: 2N | range: 103W | meridian: 6 |
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| MIT Details: |
| Test Type: | VERIFICATION OF REPAIRS |
| Repair Type: | TUBING/PACKER LEAK |
| Repair Desc: | installed new tubing and packer |
| Test Date: | 7/7/2003 |
| Field Rep: | |
| Approved Date: | 1/9/2004 |
| Approved by: | ADKINS, JAIME |
| Last Approved MIT: | 6/29/1998 |
| Injection/Producing Formation Zones: | WEBR |
| Perforation Interval: | 5744 - 6138 |
| Open Hole Interval: | NA |
| Bridge/Cement Plug Depth: | |
| Tubing Size: | 2.875 |
| Tubing Depth: | 5624 |
| Top Packer Depth: | 5486 |
| Multiple Packers: | Y |
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| Condition of approval: |
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| Test Data: | Wellbore Channel Test: | | Reading Type | Pressure | | 10 MIN CASE | 805 | | 5 MIN CASE | 820 | | CASE BEFORE | 0 | | FINAL CASE | 795 | | FINAL TUBE | 0 | | INITIAL TUBE | 0 | | LOSS OR GAIN | -40 | | START CASE | 835 |
| | Channel Test | Test Date | | TRACER SURVEY | 12/3/2001 |
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