U.S. Department of the Interior 
Minerals Management Service	Submit original plus one copy	OMB Control NO. 1010-0041
Expiration Date: June 30, 2003	
BOTTOMHOLE PRESSURE SURVEY REPORT	
Field	Lease	Well Completion No.	Reservoir Name	Operator Name & Address	
API#	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 250.196.  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 1 hour per response, including the 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 form to the Information Collection Clearance Officer, Mail Stop 4230, Minerals Management Service, 1849 C Street, NW, Washington, DC, 20240.	
MMS  FORM MMS-140   (June 2000)