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Get Monthly Disposition Report 2000-2024

MONTHLY TREATING PLANT REPORT - FORM 5P INDUSTRIAL COMMISSION OF NORTH DAKOTA Plant File Number OIL AND GAS DIVISION 600 EAST BOULEVARD DEPT 405 BISMARCK ND 58505-0840 Amended SFN 5753 03-2000 PLEASE READ INSTRUCTIONS BEFORE FILLING OUT FORM. Reset PLEASE SUBMIT THE ORIGINAL* View Print Operator Telephone Number Address City Plant Location For Month/Year Qtr-Qtr State Township Section Range Zip Code County N W Total Liquid Stored Total Residue Stored BS W First of Month Received Oil Sold Water Disposed Residue Disposed End of Month Bbls Bbls or Tons BS W SOURCE Well Name and Number File Number or Location Taken Source Point NDIC CTB No* Qtr-Qtr S-T-R Comments DISPOSITION OF RESIDUE Destination Name Location Qtr-Qtr S-T-R Disposed Bbls or Tons COMMENTS I hereby swear or affirm that the information provided is true complete and correct as determined from all available records. Signature Printed Name Title Witness Printed Name Witness Title Above Signature Witnessed By Witness Signature Date SFN 5753 1. This report is required as a regular monthly report regardless of the status of operations. 2. This completed report shall be signed and witnessed as provided for in Section 43-02-03-52 of the North Dakota Administrative Code NDAC. 3. Please refer to Sections 43-02-03-47 43-02-03-48 43-02-03-52 NDAC regarding reporting requirements for oil produced and oil sold. 4. The plant file number operator plant location well names and numbers well file numbers or central tank battery numbers and well locations shall coincide with the official records on file with the Commission* 5. Under the column headed Oil Sold indicate the amount of oil sold from the well* If a portion of the oil was taken from the well by anyone other than the parties listed on the approved Authorization to Purchase and Transport Oil from Lease - Form 8 SFN 5698 on 6. All volumes shall be reported as barrels 42 gallons corrected to 14. 73 psia and 60 degrees F* All volumes shall be rounded to the nearest full barrel* 7. If this is an amended report the amended volumes shall be clearly indicated* 8. The original of this report shall be filed with the Industrial Commission of North Dakota Oil and Gas Division 600 East Boulevard Dept. Reset PLEASE SUBMIT THE ORIGINAL* View Print Operator Telephone Number Address City Plant Location For Month/Year Qtr-Qtr State Township Section Range Zip Code County N W Total Liquid Stored Total Residue Stored BS W First of Month Received Oil Sold Water Disposed Residue Disposed End of Month Bbls Bbls or Tons BS W SOURCE Well Name and Number File Number or Location Taken Source Point NDIC CTB No* Qtr-Qtr S-T-R Comments DISPOSITION OF RESIDUE Destination Name Location Qtr-Qtr S-T-R Disposed Bbls or Tons COMMENTS I hereby swear or affirm that the information provided is true complete and correct as determined from all available records. Signature Printed Name Title Witness Printed Name Witness Title Above Signature Witnessed By Witness Signature Date SFN 5753 1. .

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