U.S. Department of the Interior
Minerals Management Service (MMS)
	Submit original plus two copies,
with one copy marked “Public Information.”	OMB Control Number 1010-0041
OMB Approval Expires 11/30/2011	
WELL POTENTIAL TEST REPORT (WPT)	
1.
  Original
  Correction	4. LEASE NO.	3. WELL NO.	2. API NO. (with Completion Code)	11. OPERATOR NAME and ADDRESS
       (Submitting Office)	
					
8. FIELD NAME	5. AREA NAME	6. BLOCK NO.	50. RESERVOIR NAME		
88. TYPE OF REQUEST
  INITIAL
  RECOMPLETION
  REWORK
  RECLASSIFICATION	89. ATTACHMENTS PER
      30 CFR 250.1102
  LOG SECTION
  RESERVOIR 	STRUCTURE MAP
  OTHER ____________	7. OPD NO.	10. MMS OPERATOR NO.	43. DATE OF FIRST PRODUCTION	
		9. UNIT NO.	90.	RESERVOIR CLASSIFICATION
	  SENSITIVE	  NONSENSIITIVE	
WELL TEST	
92. DATE of TEST	93. PRODUCTION METHOD	94. TYPE OF WELL
  OIL    GAS	95. HOURS TESTED	96. CHOKE SIZE (Test)	97. PRETEST TIME	
98. CHOKE SIZE
(Pretest)	99. SHUT-IN WELLHEAD PRESSURE
(Gas wells only)	100. FLOWING TUBING PRESSURE	101. STATIC BHP(Omit on Public Info.Copy)	
102. LINE PRESSURE (Gas wells only)	103. TOP PERFORATED INTERVAL (md)	104. BOTTOM PERFORATED INTERVAL (md)	
TEST PRODUCTION - 24 HOUR RATES	
105. OIL (BOPD)	106. GAS (MCFPD)	107. WATER (BWPD)	108. API @ 60O F	109. SP GR GAS	
115. OTHER ACTIVE COMPLETIONS IN RESERVOIR (Continue in Remarks or attach an additional sheet if necessary.)	
LEASE NO.	WELL NAME	API WELL NO.	LEASE NO.	WELL NAME	API WELL NO.	
1. 			5.			
2.			6			
3.			7.			
4.			8.			
91. REQUESTED MAXIMUM PRODUCTION RATE (MPR) (Required only for Pacific and Alaska OCS Regions.)	
26. CONTACT NAME	27. CONTACT TELEPHONE NO.	32. CONTACT E-MAIL ADDRESS	
28. AUTHORIZING OFFICIAL  (Type or print name)	29. TITLE	
30. AUTHORIZING SIGNATURE	31. DATE	
THIS SPACE FOR MMS USE ONLY	REQUESTED MPR    ACCEPTED      REJECTED (Pacific and Alaska OCS Regions)	
MMS AUTHORIZING OFFICIAL	EFFECTIVE DATE	
MMS	
FORM MMS-126 (November 2008 - Replaces all previous editions of Form MMS-126 which may not be used.) 	Page 1 of 2	

WELL POTENTIAL TEST REPORT (WPT)
116. REMARKS	
PAPERWORK REDUCTION ACT STATEMENT:  The Paperwork Reduction Act of 1995 (44. U.S.C. 3501 et seq.) requires us to inform you that this information is collected to implement the various environmental provisions of the OCS Lands Act. We use the information to determine well, lease, and field producing capability and serves as the basis for approving Maximum Production rates for certain oil and gas completions.  Responses are mandatory (43 U.S.C. 1334).  Proprietary data are covered under 30 CFR 250.197.  An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB Control Number.  Public reporting burden of this form is estimated to average 3 hours per response, including the time the geologists need to prepare the map, time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form.  Direct comments regarding the burden estimate or any other aspect of the this form to the Information Collection Clearance Officer, Mail Stop 5438, Minerals Management Service, 1849 C Street, NW, Washington, DC 20240.	
MMS	
FORM MMS-126 (November 2008 - Replaces all previous editions of Form MMS-126 which may not be used.)	Page 2 of 2