FORM 1075 –
MECHANICAL INTEGRITY
TEST
FORM 1075 –
MECHANICAL INTEGRITY
TEST
This presentation will assist you in the
completion of the Form 1075. The
mechanical integrity test.
Date of Last Revision: 2009
Rule Requirement: OAC 165:10-5-6(d)(1)
Explanation of Form: A pressure or
monitoring test must be performed on new
and existing enhanced recovery injection
wells and disposal wells. Information must be
submitted on Form 1075 and witnessed by a
Field Inspector. Forms shall be submitted to
the Conservation Division's Underground
Injection Control Department. [Reference
165:10-5-6]
Question concerning this Form: For more
information contact Underground Injection
Control at (405) 522-2764.
FORM 1075 –
MECHANICAL INTEGRITY
TEST
DATE OF THE TEST
FORM 1075 –
MECHANICAL INTEGRITY
TEST
OPERATOR’S NAME
FORM 1075 –
MECHANICAL INTEGRITY
TEST
OTC/OCC OPERATOR NUMBER
FORM 1075 –
MECHANICAL INTEGRITY
TEST
MAILING ADDRESS, PHONE NUMBER,
CITY, STATE, ZIP CODE AND FAX
NUMBER OF THE OPERATOR
FORM 1075 –
MECHANICAL INTEGRITY
TEST
TYPE OF TEST:
- INITIAL TEST
- RETREST
- CHANGE OF OPERATOR
FORM 1075 –
MECHANICAL INTEGRITY
TEST
TYPE OF WELL –
- COMMERICAL DISPOSAL
- NON-COMMERICAL DISPOSAL
- INJECTION
FORM 1075 –
MECHANICAL INTEGRITY
TEST
AUTHORIZING OCC ORDER NUMBER
FORM 1075 –
MECHANICAL INTEGRITY
TEST
ADDITIONAL ORDER NUMBERS
FORM 1075 –
MECHANICAL INTEGRITY
TEST
WELL NAME AND NUMBER
FORM 1075 –
MECHANICAL INTEGRITY
TEST
API NUMBER
FORM 1075 –
MECHANICAL INTEGRITY
TEST
LATITUDE AND LONGITUDE
FORM 1075 –
MECHANICAL INTEGRITY
TEST
LOCATION OF THE WELL –
- QUARTER SECTION CALLS
- SECTION
- TOWNSHIP
- RANGE
- COUNTY
FORM 1075 –
MECHANICAL INTEGRITY
TEST
UNIT NAME AND UNIT ORDER
NUMBER
FORM 1075 –
MECHANICAL INTEGRITY
TEST
REWORK PRIOR TO TEST? PLEASE
ATTACH A COPY OF AN EXPLANATION
IF MORE SPACE IS REQUIRED
FORM 1075 –
MECHANICAL INTEGRITY
TEST
PRESSURE TEST
- PASS
- FAIL
FORM 1075 –
MECHANICAL INTEGRITY
TEST
CASING/TUBULAR ANNULUS TESTED?
FORM 1075 –
MECHANICAL INTEGRITY
TEST
SURFACE CASING PRESSURE BEFORE
TEST
FORM 1075 –
MECHANICAL INTEGRITY
TEST
TUBULAR PRESSURE BEFORE TEST
FORM 1075 –
MECHANICAL INTEGRITY
TEST
ANNULUS PRESSURE BEFORE TEST
FORM 1075 –
MECHANICAL INTEGRITY
TEST
FLOW-BACK VOLUME
FORM 1075 –
MECHANICAL INTEGRITY
TEST
MAXIMUM PRESSURE PER OCC ORDER
FORM 1075 –
MECHANICAL INTEGRITY
TEST
PACKER DEPTH PER OCC ORDER
FORM 1075 –
MECHANICAL INTEGRITY
TEST
ACTUAL PACKER DEPTH
FORM 1075 –
MECHANICAL INTEGRITY
TEST
ESTIMATED PACKER DEPTH
FORM 1075 –
MECHANICAL INTEGRITY
TEST
STARTING TEST PRESSURE
FORM 1075 –
MECHANICAL INTEGRITY
TEST
ENDING TEST PRESSURE
FORM 1075 –
MECHANICAL INTEGRITY
TEST
POSITIVE ANNULUS PRESSURE
MONITORING?
FORM 1075 –
MECHANICAL INTEGRITY
TEST
IS THE WELL SHUT DOWN?
- YES (GIVE REASON)
- NO
FORM 1075 –
MECHANICAL INTEGRITY
TEST
ALTERNATIVE TESTING PROCEDURE
AUTHORIZED BY OCC ORDER NUMBER
FORM 1075 –
MECHANICAL INTEGRITY
TEST
PASS / FAIL
- TRACER SURVEY
- FLUID LEVEL
- TUBING PRESSURE
- FLUID DEPRESSION
FORM 1075 –
MECHANICAL INTEGRITY
TEST
CASING PATCHED OR SQUEEZED
FORM 1075 –
MECHANICAL INTEGRITY
TEST
IF YES TO CASING PATCHED OR
SQUEEZED INDICATE TYPE
- MECHANICAL CASING PATCH
- CEMENT SQUEEZE
- REMEDIAL FLUID
- PROVIDE A DESCRIPTION
FORM 1075 –
MECHANICAL INTEGRITY
TEST
PRINTED NAME OF PERSON DOING
THE TEST
FORM 1075 –
MECHANICAL INTEGRITY
TEST
SIGNATURE OF COMPANY
REPRESENTATIVE
FORM 1075 –
MECHANICAL INTEGRITY
TEST
WITNESS STATEMENT BY OCC FIELD
INSPECTOR
FORM 1075 –
MECHANICAL INTEGRITY
TEST
SIGNATURE BLOCK OF OCC FIELD
INSPECTOR