| Form 21 |  Related  Doc |
| Date Submitted: | 4/15/2011 | MIT Assigned By: | KOEHLER, BOB |
| Date Recv'd: | 4/18/2011 | API number: | 05-103-07110 |
| DocNum: | 1771298 | Facility Status: | PR |
| Operator Information: |
| Oper. No. | 16700 |
| Operator: | CHEVRON USA INC |
| Address: | 100 CHEVRON ROAD RANGELY CO 81648 |
| Type Of Facility: | WELL | Well Status: PR |
| Well Name/No. | M B LARSON |
| Operator contact: | DIANE L. PETERSON |
| Location: | | qtrqtr: SENE | section: 26 | township: 2N | range: 102W | meridian: 6 |
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| MIT Details: |
| Test Type: | VERIFICATION OF REPAIRS |
| Repair Type: | CASING LEAK |
| Repair Desc: | FEDERAL LEASE-Fed M.B. Larson D D-052241 SHUT-IN WELL-TESTED FOR TA STATUS, FAILED-REPAIRED CASING LEAK-CEMENT SQUEEZE-RETURNED WELL TO ACTIVE PRODUCTION. |
| Test Date: | 3/25/2011 |
| Field Rep: | |
| Approved Date: | 4/18/2011 |
| Approved by: | KOEHLER, BOB |
| Last Approved MIT: | N/A |
| Injection/Producing Formation Zones: | WEBR |
| Perforation Interval: | 6121-6490 |
| Open Hole Interval: | NA |
| Bridge/Cement Plug Depth: | NA |
| Tubing Size: | 2.875 |
| Tubing Depth: | 6003 |
| Top Packer Depth: | 5936 |
| Multiple Packers: | N |
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| Condition of approval: |
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| Test Data: | Wellbore Channel Test: | | Reading Type | Pressure | | 10 MIN CASE | 750 | | 5 MIN CASE | 750 | | CASE BEFORE | | | FINAL CASE | 750 | | FINAL TUBE | 0 | | INITIAL TUBE | 0 | | LOSS OR GAIN | 0 | | START CASE | 750 |
| | Channel Test | Test Date | | CBL | 3/28/2011 |
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