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SPECIALTY DRILLING EQUIPMENT APPLICATION
ASSURED NAME: _____________________________________________________________ ADDRESS: _____________________________________________________________ _____________________________________________________________ PERIOD: _____________________________________________________________ YOUR BUSINESS IS: DRILLER ____ OPERATOR ____ SERVICE COMPANY ___ OTHER___ COMPLETE DESCRIPTION OF OPERATIONS: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ YEARS IN BUSINESS: ________________________________________________________________ MAXIMUM BHA VALUE: $___________ AVERAGE BHA VALUE: $________________ IF DRILLER, DO YOU REQUIRE OPERATOR TO CARRY BLOW-OUT/CONTROL OF WELL COVER: yes/no IF OPERATOR, DO YOU CARRY BLOW-OUT/CONTROL OF WELL COVER: yes/no PREVIOUS ACTIVITY*PAST MONTHS: _______________ Being _________ Directional _________ Horizontal NEW WELLS: _______________ Being _________ Directional _________ Horizontal RE-ENTRY WELLS: ____________ Being _________ Directional _________ Horizontal MAXIMUM T. M. D.: __________________ DIR/HORIZ DISPLACEMENT: ___________________ AVERAGE T. M. D.: ___________________ DIR/HORIZ DISPLACEMENT: __________________ STATES OF OPERATION: _________________________________________________________ _________________________________________________________ FORMATIONS: _________________________________________________________ _________________________________________________________ LOSSES: *PAST MONTHS: _____________ Being ________ Directional _____________ Horizontal NEW WELLS: _____________ Being ________ Directional _____________ Horizontal RE-ENTRY WELLS: ___________ Being ________ Directional _____________ Horizontal D. O. L. LOCATION/FORMATION/REASON/EQPT LOST VALUE ___________ _______________________________________________________________ _______ ___________ _______________________________________________________________ _______ ___________ _______________________________________________________________ _______ ___________ _______________________________________________________________ _______ ___________ _______________________________________________________________ _______ * 5 Years or Time in Business if less than 5 years ANTICIPATED ACTIVITYNEXT 12 MONTHS: ________________ Being _____ Directional _________ Horizontal NEW WELLS: ________________ Being _____ Directional _________ Horizontal RE-ENTRY WELLS: ________________ Being _____ Directional _________ Horizontal MAXIMUM T. M. D.: ________________ DIR/HORIZ DISPLACEMENT: ______________________ AVERAGE T. M. D.: ________________ DIR/HORIZ DISPLACEMENT: ______________________ STATES OF OPERATION: _________________________________________________________ _________________________________________________________ FORMATIONS: _________________________________________________________ _________________________________________________________ GENERAL INFORMATIONLIST OPERATORS WORKED FOR: __________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ORLIST DRILLERS USED: ________________________________________________________________ _____________________________________________________________________________________ AVERAGE TIME IN HOLE: _________________________________________________________ ANY WET/OFFSHORE WELLS: _________________________________________________________ ADDITIONAL INFORMATION: ____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ______________________________________________________________________________________ EQUIPMENT SCHEDULEDESCRIPTION SERIAL
NO. VALUE _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
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