U.S. Department of the Interior 
Minerals Management Service

Submit original plus one copy

OMB  Control No. 1010-0041
Expiration Date: 11/30/2011

BOTTOMHOLE PRESSURE SURVEY REPORT
Field | Lease | Well Completion No. | Reservoir Name | Operator Name & Address
API No. | Date of Test |
Test Data
Shut-in Time | Bottomhole Temperature | KB Elevation | Shut-in Tubing Pressure
Product (Oil or Gas) | Test Number (1, 2, ….) | THF Elevation to sea level | Perforations

Bottomhole Pressure Points
(Attach any additional points)

Measured Depth | True Vertical Depth | Pressure | Pressure Gradient
Company Contact:_______________________________ | Phone No. _______________________

REMARKS:______________________________________________________________________________
________________________________________________________________________________________

Paperwork Reduction Act Statement: The Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.) requires us to inform you that we collect this information to implement the various environmental provisions of the OCS Land Act.  We use this information in reservoir engineering calculations for the conservation of natural resources, prevention of waste, and protection of correlative rights including Federal royalty interests.  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 for this form is estimated to average 14 hours per response, including the time for lining up the test, performing the test, reviewing instructions, gathering and maintaining data, and completing and reviewing the form.  Direct comments regarding the burden estimate or any other aspect of the form to the Information Collection Clearance Officer, Mail Stop 4230, Minerals Management Service, 1849 C Street, NW, Washington, DC, 20240.
MMS   Form MMS-140   (November 2008 – Supersedes all previous versions of form MMS-140 which may not be used).        Page 1 of 1