FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGING

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGThis presentation will assist you in the completion of the Form 1003A. The notice of temporary exemption from plugging.

Date of Last Revision: 2011

Rule Requirement: OAC 165:10-11-9

Explanation of Form: Form 1003A shall be filed with the appropriate Conservation Division District Office. [Reference 165:10-11-3 and 165:10-11-9]

Question concerning this Form: Contact your Local District Office

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGREAD INSTRUCTIONS

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGCHECK BOX ON WHETHER THIS IS AN ORIGINAL , AN AMENDMENT OR A RENEWAL APPLICATION AND WHAT THE ORIGINAL APPLICATION DATE IS

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGOPERATOR’S NAME, ADDRESS AND OPERATOR’S NUMBER

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGLEASE/WELL NAME AND NUMBER

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGAPI NUMBER

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGOTC (OKLAHOMA TAX COMMISSION) LEASE NUMBER

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGSPOT LOCATION AND FOOTAGE FROM THE SOUTH AND THE WEST LINES OF THE ¼ SECTION

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGLEGAL LOCATION

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGCOUNTY WHERE THE WELL IS LOCATED

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGDATE THE WELL WAS COMPLETED

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGDATE OF LAST PRODUCTION/USED AS UTILITY WELL

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGIS WELL LOCATED ON A VALID OR PRODUCING LEASE OR UNIT

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGDEPTH TO THE BASE OF TREATABLE WATER

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGSURFACE CASING SET AT WHAT DEPTH

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGLATEST TEST DATA

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGPRODUCING FORMATION(S) ALONG WITH PERFORATIONS WITH ANY SPACING SIZE/ORDER NUMBER(S)

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGDATES OF EITHER TEMPORARY ABANDONMENT, THE ORIGINAL DATE OF ABANDONED AND HOW LONG IS THE REQUESTED EXEMPTION REQUESTED (Up to 5 years)

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGREASON FOR EXEMPTION FROM PLUGGING

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGMETHOD OF TEMPORARY PLUGGING FOR THE PROTECTION OF THE TREATABLE WATER SANDS

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGDATE OF FLUID LEVEL SURVEY

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGFIELD INSPECTOR THAT WITNESSED THE TEMPORARY ABANDONMENT

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGSIGNATURE BLOCK

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGLOCAL DISTRICT OFFICES MAILING ADDRESSES AND PHONE NUMBERS

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGBORE HOLE SCHEMATIC

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGIMPORTANT INFORMATION CONCERNING TEMPORARY ABANDONMENT

FORM 1003A – NOTICE OF TEMPORARY EXEMPTION FROM PLUGGINGOCC USE ONLY – Do not write in this box