Kansas Cp 4 Template Prepare Form Here

Kansas Cp 4 Template

The Kansas CP-4 form serves as a vital document for reporting the plugging of oil and gas wells within the state. It ensures that all necessary information is collected and submitted to the Conservation Division in a timely manner. Proper completion of this form is essential for compliance with state regulations, and it must be returned within 60 days of the well's plugging date.

To fill out the Kansas CP-4 form, please click the button below.

The Kansas CP-4 form is an essential document for those involved in the oil and gas industry, specifically concerning well plugging procedures. This form must be filled out completely and submitted to the Conservation Division within 60 days of the well's plugging date. It gathers crucial information such as the operator's details, well type, and specific formations encountered during drilling. Additionally, the form requires a thorough description of the plugging process, including the materials used and their placement within the well. The operator must provide accurate depth measurements for oil, gas, and water formations, ensuring compliance with state regulations. Furthermore, the CP-4 form includes sections for the plugging contractor's information and the party responsible for plugging fees, emphasizing the importance of accountability in the process. By adhering to these guidelines, operators help maintain safety and environmental standards in Kansas's oil and gas sector.

Kansas Cp 4 - Usage Instruction

To properly complete the Kansas CP-4 form, follow these steps carefully. Ensure all required information is filled out accurately to avoid any delays in processing. Once you have completed the form, it must be submitted to the Conservation Division within 60 days from the date the well was plugged.

  1. Identify the Operator: Fill in the operator's name, license number, and address. Include city, state, and zip code.
  2. Contact Information: Provide the contact person's name and phone number.
  3. Select the Type of Well: Check the appropriate box for the type of well: Oil Well, Gas Well, Water Supply Well, or Other.
  4. Permits: Enter the SWD Permit number, ENHR Permit number, and Gas Storage Permit number if applicable. Indicate if the ACO-1 is filed and whether a well log is attached.
  5. Producing Formation(s): List all producing formations. If necessary, attach another sheet.
  6. Depth Information: Fill in the depth to the top and bottom for each formation, including total depth (T.D.).
  7. API Number and Spot Description: Provide the API number and a detailed description of the well location, including section, township, range, and distances from the section lines.
  8. County and Lease Name: Enter the county and lease name along with the well number and completion date.
  9. Approval and Completion Dates: Record the date the plugging proposal was approved and by whom. Also, fill in the dates when plugging commenced and was completed.
  10. Formation Records: Document the depth and thickness of all water, oil, and gas formations, along with casing records.
  11. Plugging Details: Describe how the well was plugged, including the method used and the type of plugs set, along with their depths.
  12. Plugging Contractor Information: Provide the contractor's license number, name, address, and phone number.
  13. Responsible Party: State the name of the party responsible for plugging fees.
  14. Signature: The operator must sign the form, affirming the truthfulness of the information provided.

After completing the form, mail it to the Kansas Corporation Commission's Conservation Division at the specified address. Ensure that all sections are filled out completely and accurately to facilitate a smooth review process.

Dos and Don'ts

When filling out the Kansas CP-4 form, follow these guidelines to ensure accuracy and compliance.

  • Do fill out all sections completely.
  • Do print clearly to avoid misinterpretation.
  • Do sign the form before submission.
  • Do provide accurate contact information.
  • Do attach any necessary additional sheets if required.
  • Don't leave any blank spaces; every section must be filled.
  • Don't use abbreviations that may cause confusion.
  • Don't forget to submit the form within 60 days from the plugging date.
  • Don't submit without reviewing for errors or omissions.

Form Properties

Fact Name Description
Form Purpose The Kansas CP-4 form is used to document the plugging of oil and gas wells.
Filing Deadline Operators must complete and return the form within 60 days from the date of plugging.
Governing Law This form is governed by Kansas Administrative Regulation K.A.R. 82-3-117.
Required Information All sections of the form must be filled out completely and signed.
Contact Information Operators must provide their license number, name, address, and contact person details.
Mailing Address The completed form should be mailed to KCC - Conservation Division, Wichita, Kansas.

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Preview - Kansas Cp 4 Form

NOTICE:

Fill out COMPLETELY

and return to Conservation Division at the address below within

60 days from plugging date.

KANSAS CORPORATION COMMISSION

Form CP-4

OIL & GAS CONSERVATION DIVISION

March 2009

Type or Print on this Form

 

WELL PLUGGING RECORD

Form must be Signed

All blanks must be Filled

K.A.R. 82-3-117

 

OPERATOR: License #:

Name:

Address 1:

Address 2:

City:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State:

 

 

 

Zip:

 

 

 

 

+

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contact Person:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone: (

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Oil Well

 

 

 

Gas Well

 

OG

 

 

D&A

 

 

 

 

 

 

Cathodic

 

 

Type of Well: (Check one)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Water Supply Well

 

 

 

Other:

 

 

 

 

 

 

 

 

 

 

 

 

SWD Permit #:

 

 

 

 

ENHR Permit #:

 

 

 

 

 

 

 

 

 

 

 

 

Gas Storage Permit #:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is ACO-1 filed?

 

 

 

 

 

Yes

 

 

No

 

 

 

 

 

If not, is well log attached?

 

 

 

 

 

Yes

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Producing Formation(s): List All (If needed attach another sheet)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Depth to Top:

 

 

 

 

 

 

 

Bottom:

 

 

 

 

 

T.D.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Depth to Top:

 

 

 

 

 

 

 

 

Bottom:

 

 

 

 

T.D.

 

 

 

 

 

 

 

 

 

 

 

 

 

Depth to Top:

 

 

 

 

 

 

 

Bottom:

 

 

 

 

 

T.D.

 

 

 

 

 

 

 

 

API No. 15 -

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Spot Description:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

-

 

 

 

-

 

 

Sec.

 

 

Twp.

 

 

 

 

S.

R.

 

 

 

 

 

East

 

 

West

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Feet from

 

 

 

 

North /

 

 

 

 

South

Line of Section

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Feet from

 

 

 

East /

 

 

 

 

West

Line of Section

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Footages Calculated from Nearest Outside Section Corner:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NE

 

 

 

 

 

 

NW

 

 

SE

 

 

SW

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

County:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lease Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Well #:

 

 

 

 

 

 

 

 

Date Well Completed:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The plugging proposal was approved on:

 

 

 

 

 

 

 

 

 

 

 

 

(Date)

by:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(KCC DISTRICT Agent’s Name)

Plugging Commenced:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Plugging Completed:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Show depth and thickness of all water, oil and gas formations.

 

Oil, Gas or Water Records

 

Casing Record (Surface, Conductor & Production)

 

 

 

 

 

 

 

 

Formation

 

Content

Casing

 

Size

Setting Depth

Pulled Out

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Describe in detail the manner in which the well is plugged, indicating where the mud fluid was placed and the method or methods used in introducing it into the hole. If cement or other plugs were used, state the character of same depth placed from (bottom), to (top) for each plug set.

Plugging Contractor License #:

 

 

 

Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address 1:

 

 

 

 

 

 

 

Address 2:

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

 

 

 

 

 

 

 

 

State:

 

Zip:

 

+

 

 

 

 

 

 

 

Phone: (

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Party Responsible for Plugging Fees:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State of

 

 

 

 

 

 

County,

 

 

 

 

, ss.

 

 

 

 

 

 

 

 

 

 

 

Employee of Operator or

(Print Name)

Operator on above-described well,

being first duly sworn on oath, says: That I have knowledge of the facts statements, and matters herein contained, and the log of the above-described well is as filed, and the same are true and correct, so help me God.

Signature:

Mail to: KCC - Conservation Division, 130 S. Market - Room 2078, Wichita, Kansas 67202

Misconceptions

Misconceptions about the Kansas CP-4 form can lead to confusion and potential issues in the well-plugging process. Here are nine common misunderstandings:

  1. The CP-4 form is optional. Many people believe that submitting the CP-4 form is not mandatory. In reality, it is a requirement that must be completed and submitted within 60 days of the plugging date.
  2. Only the operator needs to fill out the form. Some assume that only the operator is responsible for completing the form. However, all relevant parties involved in the plugging process should ensure that the form is accurately filled out.
  3. All sections of the form are not necessary. There is a misconception that some sections of the form can be left blank. In fact, every blank must be filled to ensure compliance with regulations.
  4. Filing the form is the last step. Many believe that submitting the CP-4 form is the final requirement. It is crucial to remember that the well must also be plugged according to the approved proposal.
  5. Only one signature is required. Some individuals think that only the operator’s signature is needed. The form must be signed by the party responsible for the plugging fees as well.
  6. The form can be submitted electronically. There is a belief that the CP-4 form can be submitted online. However, it must be printed, filled out completely, and mailed to the Conservation Division.
  7. There is no need to keep a copy of the form. Some assume that once the form is mailed, they do not need to retain a copy. Keeping a copy is essential for your records and may be needed for future reference.
  8. Only oil wells require a CP-4 form. It is a common misconception that the CP-4 form is only necessary for oil wells. In fact, it applies to all types of wells, including gas and water supply wells.
  9. The plugging process is straightforward and requires no documentation. Many people underestimate the complexity of the plugging process. Detailed documentation is essential, and the CP-4 form serves as an important record of compliance.

Understanding these misconceptions can help ensure that the well-plugging process is conducted smoothly and in accordance with state regulations.

Documents used along the form

The Kansas CP-4 form serves as a vital document for well plugging records in the oil and gas industry. Alongside this form, several other documents are commonly utilized to ensure compliance with regulations and to maintain accurate records. Below is a list of related forms and documents that may accompany the Kansas CP-4 form.

  • Well Log: This document provides a detailed account of the geological formations encountered during drilling. It includes information on the depth, type of rock, and any fluids present, serving as a reference for future operations.
  • Plugging Proposal: Before plugging a well, operators must submit a proposal outlining the planned methods and materials. This document requires approval from the Kansas Corporation Commission (KCC) to ensure proper procedures are followed.
  • Notification of Well Plugging: Operators must notify the KCC of their intent to plug a well. This notification typically includes the well's identification and the expected timeline for plugging activities.
  • Completion Report: After a well is plugged, a completion report must be filed. This document summarizes the plugging process, including the materials used and the final status of the well.
  • Environmental Assessment: Depending on the location and type of well, an environmental assessment may be required. This document evaluates the potential environmental impacts of the plugging process.
  • Financial Assurance Documentation: Operators may need to provide proof of financial assurance to cover the costs of well plugging. This documentation ensures that funds are available for proper closure and remediation.
  • Virginia Motor Vehicle Bill of Sale: This document is essential for vehicle transactions in Virginia, offering legal protection and clarity for both parties involved. For further details, you can refer to the necessary resources at https://billofsaleforvehicles.com/editable-virginia-motor-vehicle-bill-of-sale.
  • Inspection Reports: These reports are generated by KCC inspectors during site visits. They assess compliance with regulations and the adequacy of the plugging process.
  • Transfer of Ownership Form: If ownership of the well changes, this form must be completed to update records with the KCC. It ensures that the new operator is responsible for compliance and any associated fees.

These forms and documents play a crucial role in the well plugging process, providing necessary information and ensuring compliance with state regulations. Operators must be diligent in completing and submitting these documents to maintain operational integrity and environmental safety.