DRILLING / WORKOVER RIG MOVEMENT NOTIFICATION REPORT

WATER LOCATIONS ONLY

DNR/OFFICE OF CONSERVATION ENGINEERING DIVISION This form is to be submitted to report the rig movement of all drilling rigs and workover rigs on all water locations under the jurisdiction of the State of Louisiana, Office of Conservation. This form is required to be submitted at least 24 hours prior to a rig arriving onto a location and again when a rig moves to different location. This report is required to be faxed to the appropriate District Office and local Conservation Enforcement Specialist where the well is located when you move the rig. See table below for contact information. This form can be found at: http://dnr.la.gov/assets/OC/drilling.docx. GENERAL INFORMATION DRILLING RIG RIG NAME & NO: RIG CONTACT: EMAIL ADDRESS: WORKOVER RIG RIG NUMBER:

SERIAL NO: OPERATOR CODE: WELL NAME: FIELD CODE: PARISH CODE:

WORK PERMIT NO: OPERATOR NAME: FIELD: PARISH:

CES NOTIFIED: WELL NO:

SECTION:

TOWNSHIP:

RANGE:

RIG ARRIVAL INFORMATION

Rig Arrival Date: Work Scheduled: Drilling Sidetrack Expected Duration of Well Operations:
Check Appropriate Work Scheduled

Completion T&A

Recompletion P&A

Workover

RIG DEPARTURE INFORMATION

Rig Departure Date: Well Status: WOCR Completed
Check Appropriate Status

Plugged Back Recompleted

Operations Suspended T&A P&A

Remarks: (Include any significant en route movements)

District Office Lafayette Monroe Shreveport

Telephone (337) 262-5777 (318) 362-3111 (318) 676-7585

Fax (225) 242-3328 (318) 362-5227 (318) 676-7486

E-mail Address Laf-drill@LA.GOV NA NA