Instructions for Form Completion

This is document is a Microsoft Word Form.

All parts of this form are locked except for those areas (fields) available for data entry.

Open this form as a “copy” in order to preserve the original for future use.

Place your curser at the beginning of the field you wish to complete.

Type in the relevant information. All fields are large enough to accommodate the data required. Fields on the form where large amounts of information are to be entered are self-expanding. If you find there is not enough room in a field to put in the information, check that the information you are entering is in the correct format.

Note that some fields have drop down lists to assist in data entry and clarity as to the type of information required. For these fields, double click on the appropriate value from the drop down list to enter that value on the form.

Once you have completed all required fields on the form, print the required number of copies, then have each copy signed and dated in blue ink by a responsible officer of the company.

The printed copies of the forms, along with the appropriate supporting technical documentation, are to be submitted to:

Chief Conservation Officer

National Energy Board

444 Seventh Avenue S.W.

Calgary AB T2P 0X8

The National Energy Board is implementing a process for submission of electronic application documents. However, until further notice, all application forms and supporting technical documentation must continue to be supplied as paper documents.

Well termination record
This record is submitted in compliance with Section 184.(1) of the Canada Oil and Gas Drilling Regulations (SOR/79-82).
Well Name:
Well ID:	Area:
Grid Area:	- - -	Field / Pool:
Interest Identifier:	Total Depth:	m
Coordinates (NAD 27):	Lat.:	° ’ ”	Long.:	° ’ ”
Elevation-KB/RT:	m	GL / Seafloor:	m
Spud Date:	Rig Release Date:
casing and cementing Program
O.D. (mm)	Weight (kg/m)	Grade	Depth Set (m KB)	Cement (m³)
plugging program
Type of Plug	Interval (m KB)	Felt	Depth (m KB)	Cement (m³)
-
-
-
-
-
Lost Circulation/Overpressure Zones:
Equipment left on Seafloor (Describe):
Provision for Re-entry (Describe and attach sketch):
Cores:	Type:
Interval:	m - m
m - m
Other Downhole Completion/Suspension:
Certification
“I certify on the basis of personal knowledge of operations undertaken at the above named well that the above information is accurate.”
Signed:
Date:
Name:	Operator:
Title:	Telephone:	( ) -
NEB USE ONLY
Current Well Status	Date:
Acknowledged by:
Suspended	File:
Chief Conservation Officer
Completed	WID:
Abandoned	UWI:

Well Termination Record

Well Termination Record

Well Termination Record

National Energy Board - NEB

2005-12-12

National Energy Board - NEB