| Form 21 |  Related  Doc |
| Date Submitted: | 4/10/2017 | MIT Assigned By: | |
| Date Recv'd: | 4/10/2017 | Facility ID: | |
| DocNum: | 401254538 | Facility Status: | |
| Operator Information: |
| Oper. No. | 16700 |
| Operator: | CHEVRON USA INC |
| Address: | 100 CHEVRON RD RANGELY CO 81648 |
| Type Of Facility: | | Well Status: |
| Facility Name | FEE |
| Operator contact: | DIANE PETERSON |
| Location: | | qtrqtr: | section: | township: | range: | meridian: |
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| MIT Details: |
| Test Type: | 5-YEAR UIC TEST |
| Test Date: | 4/5/2017 |
| Field Rep: | Browning, Chuck |
| Approved Date: | 11/1/2017 |
| Approved by: | |
| Last Approved MIT: | 4/11/2013 |
| Injection/Producing Formation Zones: | WEBR |
| Perforation Interval: | 6188-6504 |
| Open Hole Interval: | |
| Bridge/Cement Plug Depth: | |
| Tubing Size: | 2.875 |
| Tubing Depth: | 6314 |
| Top Packer Depth: | 5695 |
| Multiple Packers: | |
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| Condition of approval: |
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| Test Data: | Wellbore Channel Test: | | Reading Type | Pressure | | 10 MIN CASE | 1210 | | 5 MIN CASE | 1215 | | FINAL CASE | 1210 | | FINAL TUBE | 1664 | | INITIAL TUBE | 1664 | | LOSS OR GAIN | -10 | | START CASE | 1220 |
| No channel test. |
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