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FORM 1075 – MECHANICAL INTEGRITY TEST
FORM 1075 – MECHANICAL INTEGRITY TESTThis presentation will assist you in the completion of the Form 1075. The mechanical integrity test.
Date of Last Revision: 2009
Rule Requirement: OAC 165:10-5-6(d)(1)
Explanation of Form: A pressure or monitoring test must be performed on new and existing enhanced recovery injection wells and disposal wells. Information must be submitted on Form 1075 and witnessed by a Field Inspector. Forms shall be submitted to the Conservation Division's Underground Injection Control Department. [Reference 165:10-5-6]
Question concerning this Form: For more information contact Underground Injection Control at (405) 522-2764.
FORM 1075 – MECHANICAL INTEGRITY TEST
DATE OF THE TEST
FORM 1075 – MECHANICAL INTEGRITY TEST
OPERATOR’S NAME
FORM 1075 – MECHANICAL INTEGRITY TEST
OTC/OCC OPERATOR NUMBER
FORM 1075 – MECHANICAL INTEGRITY TEST
MAILING ADDRESS, PHONE NUMBER, CITY, STATE, ZIP CODE AND FAX NUMBER OF THE OPERATOR
FORM 1075 – MECHANICAL INTEGRITY TEST
TYPE OF TEST: - INITIAL TEST - RETREST - CHANGE OF OPERATOR
FORM 1075 – MECHANICAL INTEGRITY TEST
TYPE OF WELL – - COMMERICAL DISPOSAL - NON-COMMERICAL DISPOSAL - INJECTION
FORM 1075 – MECHANICAL INTEGRITY TEST
AUTHORIZING OCC ORDER NUMBER
FORM 1075 – MECHANICAL INTEGRITY TEST
ADDITIONAL ORDER NUMBERS
FORM 1075 – MECHANICAL INTEGRITY TEST
WELL NAME AND NUMBER
FORM 1075 – MECHANICAL INTEGRITY TEST
API NUMBER
FORM 1075 – MECHANICAL INTEGRITY TEST
LATITUDE AND LONGITUDE
FORM 1075 – MECHANICAL INTEGRITY TEST
LOCATION OF THE WELL – - QUARTER SECTION CALLS - SECTION - TOWNSHIP - RANGE - COUNTY
FORM 1075 – MECHANICAL INTEGRITY TEST
UNIT NAME AND UNIT ORDER NUMBER
FORM 1075 – MECHANICAL INTEGRITY TEST
REWORK PRIOR TO TEST? PLEASE ATTACH A COPY OF AN EXPLANATION IF MORE SPACE IS REQUIRED
FORM 1075 – MECHANICAL INTEGRITY TEST
PRESSURE TEST - PASS - FAIL
FORM 1075 – MECHANICAL INTEGRITY TEST
CASING/TUBULAR ANNULUS TESTED?
FORM 1075 – MECHANICAL INTEGRITY TEST
SURFACE CASING PRESSURE BEFORE TEST
FORM 1075 – MECHANICAL INTEGRITY TEST
TUBULAR PRESSURE BEFORE TEST
FORM 1075 – MECHANICAL INTEGRITY TEST
ANNULUS PRESSURE BEFORE TEST
FORM 1075 – MECHANICAL INTEGRITY TEST
FLOW-BACK VOLUME
FORM 1075 – MECHANICAL INTEGRITY TEST
MAXIMUM PRESSURE PER OCC ORDER
FORM 1075 – MECHANICAL INTEGRITY TEST
PACKER DEPTH PER OCC ORDER
FORM 1075 – MECHANICAL INTEGRITY TEST
ACTUAL PACKER DEPTH
FORM 1075 – MECHANICAL INTEGRITY TEST
ESTIMATED PACKER DEPTH
FORM 1075 – MECHANICAL INTEGRITY TEST
STARTING TEST PRESSURE
FORM 1075 – MECHANICAL INTEGRITY TEST
ENDING TEST PRESSURE
FORM 1075 – MECHANICAL INTEGRITY TEST
POSITIVE ANNULUS PRESSURE MONITORING?
FORM 1075 – MECHANICAL INTEGRITY TEST
IS THE WELL SHUT DOWN? - YES (GIVE REASON) - NO
FORM 1075 – MECHANICAL INTEGRITY TEST
ALTERNATIVE TESTING PROCEDURE AUTHORIZED BY OCC ORDER NUMBER
FORM 1075 – MECHANICAL INTEGRITY TEST
PASS / FAIL - TRACER SURVEY - FLUID LEVEL - TUBING PRESSURE - FLUID DEPRESSION
FORM 1075 – MECHANICAL INTEGRITY TEST
CASING PATCHED OR SQUEEZED
FORM 1075 – MECHANICAL INTEGRITY TEST
IF YES TO CASING PATCHED OR SQUEEZED INDICATE TYPE - MECHANICAL CASING PATCH - CEMENT SQUEEZE - REMEDIAL FLUID - PROVIDE A DESCRIPTION
FORM 1075 – MECHANICAL INTEGRITY TEST
PRINTED NAME OF PERSON DOING THE TEST
FORM 1075 – MECHANICAL INTEGRITY TEST
SIGNATURE OF COMPANY REPRESENTATIVE
FORM 1075 – MECHANICAL INTEGRITY TEST
WITNESS STATEMENT BY OCC FIELD INSPECTOR
FORM 1075 – MECHANICAL INTEGRITY TEST
SIGNATURE BLOCK OF OCC FIELD INSPECTOR
