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COGIS - Mechanical Integrity Test Report

Facility Type	Facility ID/ API	Facility Name/ Number	Operator Name/ Number	Status	Field Name/ Number	Location	Location ID	Related Facilities
WELL	05-103-09282	LACY, S B 2AX	SCOUT ENERGY MANAGEMENT LLC 10779	IJ 10/12/2022	RANGELY 72370	RIO BLANCO 103 NWSW 24 2N103W 6	315805	Related

Form 21

Date Submitted:

4/17/2023

MIT Assigned By:

Date Recv'd:

4/17/2023

Facility ID:

DocNum:

403375664

Facility Status:

Operator Information:

Oper. No.

16700

Operator:

CHEVRON USA INC

Address:

760 HORIZON DRIVE STE 401 GRAND JUNCTION CO 81506

Type Of Facility:

Well Status:

Facility Name

LACY, S B

Operator contact:

Anita Sanford

Location:

qtrqtr:

section:

township:

range:

meridian:

MIT Details:

Test Type:

5-YEAR UIC TEST

Test Date:

4/13/2023

Field Rep:

Browning, Chuck

Approved Date:

4/20/2023

Approved by:

Last Approved MIT:

5/18/2018

Injection/Producing Formation Zones:

WEBR

Perforation Interval:

5941-6567

Open Hole Interval:

Bridge/Cement Plug Depth:

Tubing Size:

2.875

Tubing Depth:

6586

Top Packer Depth:

5701

Multiple Packers:

Condition of approval:

Test Data:

Wellbore Channel Test:

Reading Type	Pressure
10 MIN CASE	1240
5 MIN CASE	1250
FINAL CASE	1240
FINAL TUBE	1579
INITIAL TUBE	1579
LOSS OR GAIN	-15
START CASE	1255

No channel test.