Completing Form H-5

Items 1 through 11. IDENTIFICATION
Standard identification information. The same information is preprinted on the Annual Monitoring Report (Form H-10). 

Item 12. REASON FOR TEST
Report the reason for conducting the test 

Item 13. DATE OF TEST
Report the date the test was conducted 

Item 14. RETEST? (Instruction 5)
Check the box if this is a retest after an unsuccessful testReport date of last unsuccessful test.Describe action taken to repair well for retest in Item 24. 

Item 15. WELL COMPLETION
Indicate size and setting depth of surface casing, production casing, and tubing.Write "N/A" (or "Not Applicable") if an item does not apply. 

Item 16a.PACKER MAKE AND MODEL, 
Item 16b.DEPTH SET
If an alternative survey is run, write "N/A" in these sections.Indicate depth of packer or plug if the well is equipped for casing injection and is being tested against a temporary packer/plug. 

NOTE: Only the following categories of wells are authorized to inject without tubing and packer:
  • Rule 9 disposal well with an exception.
  • Rule 46 injection well permitted after April 23, 1982, with an exception.
  • Rule 46 injection well permitted before April 23, 1982, without a tubing and packer requirement in the permit. These wells were grandfathered.

Item 17. AUTHORIZED INJECTION PRESSURE
The authorized injection pressure determines required test pressure.Obtain from the permit (or from the permit application for older permits).If not specified on permit or permit application, indicate the maximum operating pressure reported on the most recent Form H-10. 

Item 18a. PERMITTED INJECTION INTERVAL
Specify top and bottom of permitted interval.Average top will be accepted for Rule 46 wells. 

Item 18b. COMPLETED INJECTION INTERVAL
Indicate top and bottom of currently completed interval. 

Item 19. TEST PRESSURE
Show a minimum of three readings each for tubing, casing, and surface casing pressures.Surface casing readings will not apply to all wells. 

Item 20 CHACTERISTICS OF INJECTION FLUID (Instructions 4(e))
Not required to be completed unless a pressure anomaly occurs during the test that can be accounted for by some physical factor that can be explained by the injection fluid. 

Item 21 CHARACTERISTICS OF ANNULUS FLUID (Instructions 4(e) and 4(f))
Not required to be completed unless a pressure anomaly occurs during the test that can be accounted for by some physical factor that can be explained by the annulus fluid. 

NOTE: Wells that inject liquids, are required by Rule to test with a liquid-filled annulus.

NOTE: Rules 9 and 46 expressly prohibit the use of any packer fluid additives (e.g. drilling mud, polymer or silica gels, etc.) "that may affect the sensitivity or otherwise reduce the effectiveness of the test."

Item 22. TEST WITNESSED?
If yes is checked, the district office will verify that the test was witnessed and will attach a copy of the field inspector's report. 

Item 23. OTHER TESTS RUN?
Indicate if alternative surveys were run:- To locate leaks.- To test a casing injection well. 

Item 24. COMMENTS
Provide any additional information necessary to evaluate the test results. 

Item 25. STATUS
Indicate the current operating status of the well.

Last Updated: 7/21/2015 4:49:48 AM