| Form 21 |  Related  Doc |
| Date Submitted: | 5/10/2013 | MIT Assigned By: | KOEHLER, BOB |
| Date Recv'd: | 5/14/2013 | API number: | 05-103-08700 |
| DocNum: | 1772643 | Facility Status: | AC |
| Operator Information: |
| Oper. No. | 16700 |
| Operator: | CHEVRON USA INC |
| Address: | 100 CHEVRON ROAD RANGELY CO 81648 |
| Type Of Facility: | WELL | Well Status: AC |
| Well Name/No. | UNION PACIFIC |
| Operator contact: | DIANE L. PETERSON |
| Location: | | qtrqtr: NENE | section: 21 | township: 2N | range: 102W | meridian: 6 |
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| MIT Details: |
| Test Type: | SI/TA MAINTENANCE STATUS |
| Test Date: | 5/7/2013 |
| Field Rep: | |
| Approved Date: | 5/15/2013 |
| Approved by: | KOEHLER, BOB |
| Last Approved MIT: | 2/27/2012 |
| Injection/Producing Formation Zones: | WEBR |
| Perforation Interval: | 6421-6608 |
| Open Hole Interval: | NA |
| Bridge/Cement Plug Depth: | NA |
| Tubing Size: | 2.875 |
| Tubing Depth: | 6331 |
| Top Packer Depth: | 6295 |
| Multiple Packers: | N |
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| Condition of approval: |
| Form 5A submitted 5/7/2013 (Doc # 400414924) to update perfs. |
| Test Data: | Wellbore Channel Test: | | Reading Type | Pressure | | 10 MIN CASE | | | 5 MIN CASE | | | CASE BEFORE | 0 | | FINAL CASE | 350 | | FINAL TUBE | | | INITIAL TUBE | | | LOSS OR GAIN | 0 | | START CASE | 350 |
| No channel test. |
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