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  • La Form Ssta (9604-1)

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D Name ____________________________________________________________________Field Code ____________________ Operator_____________________________________________________________________Operator Code __________________ Contractor Performing Reassessment______________________________________________________________________________ Contact Person and Phone Number__________________________________________________________________ Well Name* Well Number Serial Number PBTD Estimated Cost to P&A $ $ .

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How to fill out the LA Form SSTA (9604-1) online

Filling out the LA Form SSTA (9604-1) online can seem daunting, but with clear, step-by-step guidance, you can navigate through the process with ease. This guide provides detailed instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete the LA Form SSTA (9604-1) online.

  1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
  2. Begin by entering the date at the top of the form in the designated field.
  3. Input your SSTA number in the corresponding field provided.
  4. Fill out the field name and field code sections with the relevant information pertaining to your site.
  5. Next, enter the operator's name and operator code in the respective fields.
  6. Identify the contractor performing the reassessment by filling in their details.
  7. Provide the contact person's name and phone number for any follow-up queries.
  8. List the well name, well number, and serial number accurately.
  9. Fill in the PBTD (Plugged Back to Depth) information as required.
  10. Estimate the costs for the Plugging and Abandonment (P&A) in the provided sections.
  11. For the pits associated with the site, enter the ID number and the estimated cost to close in the respective fields.
  12. Record the production equipment details by listing each piece of equipment needed.
  13. If necessary, attach an addendum for additional entries on production equipment.
  14. Calculate and summarize the total P&A cost, total pit closure cost, total equipment removal cost, production platform removal cost, underwater obstruction removal and site clearance verification cost, surface restoration cost, and other restoration costs in the indicated fields.
  15. Add the total site restoration cost and ensure to attach a detailed explanation of all factors considered in estimating costs.
  16. Indicate your method of funding by selecting from the three acceptable methods: Cash, Performance Bond, or Letter of Credit.
  17. Sign the form as the operator, ensuring your printed name and title are clearly included.
  18. For office use only sections should remain blank unless instructed otherwise.
  19. Once all sections are completed, save your changes, download, print, or share the form as required.

Take the next step and complete your LA Form SSTA (9604-1) online today!

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FORM 9604-1: Site Specific Trust Account...
DEPARTMENT OF NATURAL RESOURCES. REASSESSMENT OF OILFIELD SITE RESTORATION COSTS. SITE...
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WI DHS F-60287 2011 MA F5159 2010 NY Standard Insurance Company SNY 9457 2012 BVI Form 20a

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