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Get KCC U3C 2013

KANSAS CORPORATION COMMISSION Form U3C August 2013 OIL GAS CONSERVATION DIVISION Form must be Typed Form must be completed on a per well basis ANNUAL REPORT OF PRESSURE MONITORING FLUID INJECTION AND ENHANCED RECOVERY Complete all blanks - add pages if needed. Copy to be retained for five 5 years after filing date. OPERATOR License Permit Number E D - Name API No* Address 1 Reporting Period January 1 20 City State Zip - to December 31 20 Q/Q/Q/Q Contact Person Phone 15- Sec* Twp* S* R* E W Lease Name N / S Line of Section feet from E / Legal Description of Lease or Unit Well Number County If new operator list previous operator I. Injection Fluid Type Fresh Water Treated Brine Untreated Brine Water/Brine Source Quality Attach water analysis if available Produced Water Other Attach List Total Dissolved Solids mg/l Specific Gravity Additives II. Well Data Type Completion Maximum Authorized Injection Pressure Total Number of Enhanced Recovery Injection Wells Covered by This Permit Tubing packer packer setting depth III. Month BBL feet Packerless tubing but no packer psi Tubingless Injection Zone barrels per day Include TA s Total Volume Injected Days of Injection MCF Maximum Injection Pressure February March April May June July August September October November December TOTAL Print and Mail to KCC - Conservation Division 130 S* Market - Room 2078 Wichita Kansas 67202 Average Pressure Tubing/Casing Annulus. OPERATOR License Permit Number E D - Name API No* Address 1 Reporting Period January 1 20 City State Zip - to December 31 20 Q/Q/Q/Q Contact Person Phone 15- Sec* Twp* S* R* E W Lease Name N / S Line of Section feet from E / Legal Description of Lease or Unit Well Number County If new operator list previous operator I. Injection Fluid Type Fresh Water Treated Brine Untreated Brine Water/Brine Source Quality Attach water analysis if available Produced Water Other Attach List Total Dissolved Solids mg/l Specific Gravity Additives II. Injection Fluid Type Fresh Water Treated Brine Untreated Brine Water/Brine Source Quality Attach water analysis if available Produced Water Other Attach List Total Dissolved Solids mg/l Specific Gravity Additives II. Well Data Type Completion Maximum Authorized Injection Pressure Total Number of Enhanced Recovery Injection Wells Covered by This Permit Tubing packer packer setting depth III. Well Data Type Completion Maximum Authorized Injection Pressure Total Number of Enhanced Recovery Injection Wells Covered by This Permit Tubing packer packer setting depth III. Month BBL feet Packerless tubing but no packer psi Tubingless Injection Zone barrels per day Include TA s Total Volume Injected Days of Injection MCF Maximum Injection Pressure February March April May June July August September October November December TOTAL Print and Mail to KCC - Conservation Division 130 S* Market - Room 2078 Wichita Kansas 67202 Average Pressure Tubing/Casing Annulus. OPERATOR License Permit Number E D - Name API No* Address 1 Reporting Period January 1 20 City State Zip - to December 31 20 Q/Q/Q/Q Contact Person Phone 15- Sec* Twp* S* R* E W Lease Name N / S Line of Section feet from E / Legal Description of Lease or Unit Well Number County If new operator list previous operator I. Injection Fluid Type Fresh Water Treated Brine Untreated Brine Water/Brine Source Quality Attach water analysis if available Produced Water Other Attach List Total Dissolved Solids mg/l Specific Gravity Additives II. Well Data Type Completion Maximum Authorized Injection Pressure Total Number of Enhanced Recovery Injection Wells Covered by This Permit Tubing packer packer setting depth III. .

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