| Form 21 |  Related  Doc |
| Date Submitted: | 1/19/2009 | MIT Assigned By: | KOEHLER, BOB |
| Date Recv'd: | 1/23/2009 | Facility ID: | 150200 |
| DocNum: | 1769247 | Facility Status: | AC |
| Operator Information: |
| Oper. No. | 16700 |
| Operator: | CHEVRON U S A INC |
| Address: | 100 CHEVRON ROAD RANGELY CO 61648 |
| Type Of Facility: | UIC ENHANCED RECOVERY | Well Status: AC |
| Facility Name | FEE |
| Operator contact: | DIANE L 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: | OTHER |
| Repair Desc: | MIT CHART TO VERIFY INTEGRITY. |
| Test Date: | 1/14/2009 |
| Field Rep: | |
| Approved Date: | 1/26/2009 |
| Approved by: | KOEHLER, BOB |
| Last Approved MIT: | 9/1/2004 |
| Injection/Producing Formation Zones: | WEBR |
| Perforation Interval: | 6247-6500 |
| Open Hole Interval: | NA |
| Bridge/Cement Plug Depth: | NA |
| Tubing Size: | 2.875 |
| Tubing Depth: | 6516 |
| Top Packer Depth: | 5821 |
| Multiple Packers: | Y |
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| Condition of approval: |
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| Test Data: | Wellbore Channel Test: | | Reading Type | Pressure | | No test data. |
| No channel test. |
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