APPLICATION TO CONDUCT SEISMIC OR INFORMATION HOLE DRILLING OPERATIONS
STATE OF OREGON  DEPT OF GEOLOGY & MINERAL INDUSTRIES  229 BROADALBIN ST SW  ALBANY OR 97321
(In compliance with rules and regulations pursuant to ORS 520.)
(1) Permittee Information
(2) Project Information
Name
Project or Well Name
Mailing Address
Type (check one)
City/State/Zip
County(ies)
Telephone
Location
Fax
Wildcat or Field
Email
Anticipated Start Date
Prepared by
Anticipated Completion
(3) Contractor Information
Seismic
Information
(4) Plugger Information
Name
Name
Mailing Address
Mailing Address
City/State/Zip
City/State/Zip
Phone
Phone
Email
Email
Signature
Title
Date
(5) Lease/Ownership (if other than applicant)
Lessor (mineral owner)
Surface Owner
Lessee
Name
Mailing Address
City/State/Zip
Telephone
Fax
Email
(6) Proposed Well Design (use additional sheets if necessary)
Number of Holes
Size of holes
Depth Range
For Seismic Holes: size of explosive charges
lbs
lbs
(7) Slurry Design for each String (use additional sheets if necessary)
String 1
Annulus
height
HT. left
in casing
Excess
Annulus
height
String 2
Density
HT. left
in casing
Excess
Density
Tail
ft.
ft.
bbls.
ppg.
Tail
ft.
ft.
bbls.
ppg.
Lead
ft.
ft.
bbls.
ppg.
Lead
ft.
ft.
bbls.
ppg.
(8) Geologic Information - if known (use additional sheets if necessary)
1
at
2
at
3
at
Assumed fracture gradient of rock vs. depth
psi/ft
ft.
psi/ft
ft.
psi/ft
ft.
Pore gradient of rock vs. depth (if known)
psi/ft
ft.
psi/ft
ft.
psi/ft
ft.
533572218
REV. 02-2008
APPLICATION TO CONDUCT SEISMIC OR INFORMATION HOLE DRILLING OPERATIONS
STATE OF OREGON  DEPT OF GEOLOGY & MINERAL INDUSTRIES  229 BROADALBIN ST SW  ALBANY OR 97321
(In compliance with rules and regulations pursuant to ORS 520.)
REQUIREMENTS
A complete application is required to obtain a permit to conduct seismic or information hole drilling operations.
A complete application consists of:
1.
2.
3.
4.
This completed application form. We must have original signatures for our records.
Hole location map.
The application fee.
A drilling bond.
Submit an electronic version of the application and all supporting documents via email or CD.
APPLICATION FORM
The application is generally self-explanatory. Clarifying notes are listed below:
Section 1
If the applicant is other than an individual, the entity must be registered to do business in Oregon if required by the Secretary
of State’s office. Secretary of State’s web site: http://www.sos.state.or.us/
533572218
REV. 02-2008