OKLAHOMA CORPORATION COMMISSION
Form 1024
Oil & Gas Conservation Division
Rev. 2001
Post Office Box 52000
Oklahoma City, Oklahoma 73152-2000
Packer Setting Report
Operator
OCC No.
Address
Phone No.
City
State
Zip
FAX No.
Well Name/No.
API No.
OTC No.
Location within Section
Sec
Twp
Rge
County
Make/Type of Packer
Packer Depth Set
Date Packer Set
Service Company Name
Service Co. Representative
I, the undersigned, being of lawful age and having full knowledge of the facts herein set out do certify that the data and facts presented are true, correct
and complete. That the purpose of setting this packer was to effect a seal in the annular space between two strings of pipe where the packer was set
so as to prevent the commingling, in the bore of this well, of fluids produced from a stratum below the packer with fluids produced from a stratum above the
packer; that this packer was properly set and that it did, when set, effectively and absolutely seal off the annular space between the two strings of pipe
where it was set in such manner as that it prevented any movement of fluids across the packer.
Signature
Date
Name & Title (Typed or Printed)
STATE OF OKLAHOMA
)
)
)
SS:
)
COUNTY OF
)
Subscribed and sworn to before me, a Notary Public, this
day of
,
.
My Commission Expires:
Notary PublicDIAGRAMMATIC SKETCH SHOWING MULTIPLE COMPLETION INSTALLATION
Date
Operator
Lease
Location within Sec.
Sec
Twp
Rge
County
Field
Casing Set Depth
Total Depth
Top at
Feet
UPPER ZONE Name
Perforated
Feet
Completion this zone:
This zone produced thru:
Bottom at
Feet
Packer set at
Feet
Tubing Landed at
Feet
Top at
Feet
LOWER ZONE Name
Perforated
Feet
Completion this zone:
This zone produced thru:
Bottom at
Feet
NOTE:
This form is furnished only as an example. The diagrammatic sketch which is filed should depict the particular installation for which approval is
being requested.
