1. Name and Mailing Address
2. Description of the Property (A Separate Report Must be Filed for Each Property)
3. Parcel Number
4. Well data:
Type:
Dry steam
Water
Hot rock
5. Producing wells flowing
6. Producing wells pumping
7. Shut-in wells capable of producing
8. Idle wells incapable of producing
a. With equipment
b. Without equipment
9. Injection wells
10. Water supply
Fresh
Salt
11. Disposal wells
Field Operating Expenses:*
12. Labor (including employee benefits)
13. Materials and supplies (expensed items only)
14. Well maintenance (pulling, bailing, etc.)
15. Contract work and rentals
16. Insurance
17. Utilities
18. Injection
19. Transportation
20. Waste water disposal
21. Waste disposal (sludge)
22. Overhead (direct -field or district) (see instructions)
23. Other (fully explain on attached sheet)
24.
25.
26.
27.
28.
29. Total Field Operating Expeses
CAPITAL EXPENDITURES (during the calendar year being reported):
30. New wells
*P=Producing, I=Injection, D=Disposal
Total New Well Cost $
31. Remedial well work
Total Remedial Well Work Cost
32. Abandonments
Total Abandonment Cost (net)
33. Surface investment
Total Surface Investment
34. Other (fully explain on attached sheet)
35. Total Capital Expenditures
