| Agency | Form: (02) 1791135 12/22/2009 |
24-HOUR SPUD NOTICE REQUIRED. E-MAIL david.Andrews@state.co.us
APPROVAL OF THIS FORM DOES NOT AUTHORIZE INJECTION. AUTHORIZATION TO INJECT REQUIRES APPROVAL OF FORM 31 AND FORM 33.
CEMENT-TOP VERIFICATION BY CBL REQUIRED.
THE PROPOSED SURFACE CASING IS MORE THAN 50’ BELOW THE DEPTH OF THE DEEPEST WATER WELL WITHIN 1-MILE OF THE SURFACE LOCATION WHEN CORRECTED FOR ELEVATION DIFFERENCES. THE DEEPEST WELL USED FOR DRINKING OR POTABLE OR AGRICULTURAL PURPOSES WITHIN 1-MILE IS 000 FEET DEEP. |
| Engineer | Form: (04) 401740817 10/01/2018 | This approval is good for one year and a new application must be made before January 22, 2019(1 year from prior application). Updates for the planned utilization of the well should be included with the application. |
| Engineer | Form: (04) 401873038 04/22/2019 | This approval is good for one year and a new application must be made before January 22, 2020(1 year from prior application). Updates for the planned utilization of the well should be included with the application. |
| Engineer | Form: (04) 402269619 03/26/2020 | 1) This approval is good for one year and a new application must be made before 1/9/2021 (1 year from prior application). Updates for the planned utilization of the well should be included with the application.
2) The Form 7 reporting must reflect the well status dates reported on the Form 4-TA request.
3) A Form 5A is required to report all plugs currently downhole which isolate the perforated interval.
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| Engineer | Form: (04) 402551570 04/19/2021 | 1) This approval is good for one year and a new application must be made before 01/09/2022 (1 year from prior application). Updates for the planned utilization of the well should be included with the application.
2) The Form 7 reporting must reflect the well status dates reported on the Form 4-TA request.
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| Engineer | Form: (04) 402905131 01/27/2022 | 1) This approval is good for one year and a new application must be made before 01/09/2023 (1 year from prior application). Updates for the planned utilization of the well should be included with the application.
2) The Form 7 reporting must reflect the well status dates reported on the Form 4-TA request.
4) Submit a Wellbore Diagram on a Form 4 Sundry
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| UIC | Form: (04) 403220957 04/04/2023 | Updated well classification to Observation Well. Used 11/07/2022 as date well is no longer an injector. Operator to report this well as AC (Active) on Form 7. |