Position:
Field Employee
Office Employee
Reviewing Manager
Request Type
*
Purchase Order (Workorder will be completed later)
Purchase Order & Work Order
Work Order Only (Nothing Purchased)
Issuer Initals
Bill PO To:
Lease/Well
Crew/Vehicle (Non Billable Work Order)
Truck Number:
*
Work Date
*
-
Month
-
Day
Year
Date Picker Icon
Ticket Type
*
Employee 1
*
Employee 2
Employee 3
Employee 4
Pumper Enter Daily Time?
*
Yes
No
Time In:
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
05
10
15
20
25
30
35
40
45
50
55
Minutes
AM
PM
AM/PM Option
Time Out:
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
05
10
15
20
25
30
35
40
45
50
55
Minutes
AM
PM
AM/PM Option
Time Worked
Lease * Well No.
*
Job Status
*
Hauling
*
Well Depth
*
Shallow (>2000ft)
Deep (>2000ft)
Miles
*
Swivel?
*
Please Select
Yes
No
H5 Result
*
Pass
Fail
# In Crew
*
1-2
3+
Well Failure
*
Rod/Joint # from Surface
*
Tubing POOH/RIH?
*
Tubing: POOH & RIH
Tubing: POOH Only
Tubing: RIH Only
None
Rods POOH/RIH?
*
Rods: POOH & RIH
Rods: POOH Only
Rods: RIH Only
None
Fishing Tool
*
Please Select
Yes
No
Tong Trip
*
Please Select
0
.5
1
1.5
2
2.5
3
3.5
4
Tubing Size/Type
*
Tubing POOH # Jts:
*
Tubing POOH Total Ft:
*
Tubing POOH Est:
*
Tubing RIH # Jts:
*
Tubing RIH Total Ft::
*
Tubing RIH Est:
*
Tubing Subs Ft:
*
Tubing RIH Length:
*
Tubing RIH Length Est:
*
Packer?
*
Yes
No
Packer Depth Ft:
*
Packer Type:
*
TAC?
*
Yes
No
TAC Depth Ft:
*
TAC : Length
*
Tubing Pump Depth:
*
Seat Nipple/Shoe Size:
*
Seat Nipple/Shoe Depth:
*
Perf Nipple?
*
Yes
No
Perf Nipple Depth
*
Mud Joint?
*
Yes
No
Mud Joint Length Ft:
*
Mud Joint Size:
*
Please Select
2 3/8
2 7/8
Mud Joint Depth:
*
Bull Plug?
*
Yes
No
Multipe Rod Sizes?
*
1 Rod Section
2 Rod Sections
3 Rod Sections
Rod Sub?
*
Top Only
Bottom Only
Top & Bottom
None
Polish Rod: POOH Length
*
Liner POOH: Length
*
Top POOH Sub Size
*
Please Select
5/8"
3/4"
7/8"
1"
Top POOH Sub Length
*
Bottom POOH Sub Size
*
Please Select
5/8"
3/4"
7/8"
1"
Bottom POOH Sub Length
*
1st POOH Rod Size
*
Please Select
5/8"
3/4"
7/8"
1"
1st POOH Rod Qty
*
1st POOH Rod Length
*
2nd POOH Rod Size
*
Please Select
5/8"
3/4"
7/8"
1"
2nd POOH Rod Qty
*
2nd POOH Rod Length
*
3rd POOH Rod Size
*
Please Select
5/8"
3/4"
7/8"
1"
3rd POOH Rod Qty
*
3rd POOH Rod Length
*
Sinker Bars POOH?
*
Yes
No
Sinker Bars Size POOH
*
Please Select
1 1/4
1 1/2
Sinker Bar POOH Qty:
*
Sinker POOH Length:
*
Total Rod Length POOH:
*
Back-Off Tool POOH?
*
Yes
No
Polish Rod: RIH Length
*
Liner RIH: Length
*
Top RIH Sub Size
*
Please Select
5/8"
3/4"
7/8"
1"
Top RIH Sub Length
*
Bottom RIH Sub Size
*
Please Select
5/8"
3/4"
7/8"
1"
Bottom RIH Sub Length
*
1st RIH Rod Size
*
Please Select
5/8"
3/4"
7/8"
1"
1st RIH Rod Qty
*
1st RIH Rod Length
*
2nd RIH Rod Size
*
Please Select
5/8"
3/4"
7/8"
1"
2nd RIH Rod Qty
*
2nd RIH Rod Length
*
3rd RIH Rod Size
*
Please Select
5/8"
3/4"
7/8"
1"
3rd RIH Rod Qty
*
3rd RIH Rod Length
*
Sinker Bars RIH?
*
Yes
No
Sinker Bars Size RIH
*
Please Select
1 1/4
1 1/2
Sinker Bar RIH Qty:
*
Sinker RIH Length:
*
Total Rod Length RIH:
*
Back-Off Tool RIH?
*
Yes
No
Pump Info
*
Barrel & Plunger
*
Pumping Unit Info?
*
Yes
No
Well Treatment Type
*
Frac Job
Perfs
Acidizing
Washout
Plugging
None
Perfs
*
Electrical Inventory Used?
*
Yes
No
Electrician Item 1
Please Select
#1 STARTER
#12 THHN WIRE
#3 STARTER
#4 WIRE
#6 WIRE
#8 WIRE
1 1/2 X 3/4 REDUCING BUSHING
1 1/2 X 3/4 REDUCING WASHER
1 1/4 X 3/4 REDUCING BUSHING
1 1/4 X 3/4 REDUCING WASHER
1 X 3/4 REDUCING BUSHING
1 X 3/4 REDUCING WASHER
10 AMP FUSE
10/3 WIRE
12 AMP FUSE
14/3 WIRE
15 AMP FUSE
17 1/2 LINE FUSE
17.5 AMP FUSE
2 1/2 X 3/4 REDUCING BUSHING
2 X 1/2 REDUCING BUSHING
2 X 3/4 REDUCING BUSHING
2 X 3/4 REDUCING WASHER
2" GROUND CLAMP
20 AMP FUSE
25 AMP FUSE
25’ CORD
3 AMP FUSE LINK
3/4 ROMEX CONNECTOR
3/8 ROMEX CONNECTOR
30 AMP DISCONNECT
30 AMP FUSE
30 AMP FUSE T
35 AMP FUSE
4" SQ BX COVER, STL, FLAT
40 AMP FUSE
45 AMP FUSE
480V 5A
4X4 LUMBER
5 AMP FUSE
5 H.P. INVENTORY MOTOR
5/8 GROUND RODS
50 AMP FUSE
50VA 220-480X110-120 CCT
6/3 WIRE
60 AMP DISCONNECT
60 AMP FUSE
7 AMP FUSE
70 AMP FUSE
8 AMP FUSE
8/3 WIRE
9 AMP FUSE
9/16 ROMEX STAPLE
B-CAPS BLUE
B-CAPS RED
BEAM CLAMPS
BUSS FNM-2 MIDGET FUSE
COIL KIT 240-480 SIEMENS
COIL KIT-SIEMENS
CORD 12-3 SJEOW 300V BLACK 12-3 300V BLACK CORD
GEAR OIL (GALLON)
GEN STATION, METAL HD, CMPLT, 1 HOLE
GROUND CLAMPS
GROUND RODS
HOA SWITCH
INSULATED LUGS
OVER LOAD RELAY 13-52 AMPS
OVER LOAD RELAY 25-100 AMPS
P&S 5269-X STR BLD CONN 2P 3W 15A 125V
P&S PS5266-XSTR BLD PLUG 3W 15A 125V
PUMP PANEL SIZE 2
PUMP PANEL SIZE 2, 13-52 AMPS
PUMP PANEL SIZE 3, 25-100 AMPS
PVC PIPE
STARTER SIZE 2
STARTER SIZE 3
WIRE LUGS
Electrician Item 1 Qty
*
Electrician Item 2
Please Select
#1 STARTER
#12 THHN WIRE
#3 STARTER
#4 WIRE
#6 WIRE
#8 WIRE
1 1/2 X 3/4 REDUCING BUSHING
1 1/2 X 3/4 REDUCING WASHER
1 1/4 X 3/4 REDUCING BUSHING
1 1/4 X 3/4 REDUCING WASHER
1 X 3/4 REDUCING BUSHING
1 X 3/4 REDUCING WASHER
10 AMP FUSE
10/3 WIRE
12 AMP FUSE
14/3 WIRE
15 AMP FUSE
17 1/2 LINE FUSE
17.5 AMP FUSE
2 1/2 X 3/4 REDUCING BUSHING
2 X 1/2 REDUCING BUSHING
2 X 3/4 REDUCING BUSHING
2 X 3/4 REDUCING WASHER
2" GROUND CLAMP
20 AMP FUSE
25 AMP FUSE
25’ CORD
3 AMP FUSE LINK
3/4 ROMEX CONNECTOR
3/8 ROMEX CONNECTOR
30 AMP DISCONNECT
30 AMP FUSE
30 AMP FUSE T
35 AMP FUSE
4" SQ BX COVER, STL, FLAT
40 AMP FUSE
45 AMP FUSE
480V 5A
4X4 LUMBER
5 AMP FUSE
5 H.P. INVENTORY MOTOR
5/8 GROUND RODS
50 AMP FUSE
50VA 220-480X110-120 CCT
6/3 WIRE
60 AMP DISCONNECT
60 AMP FUSE
7 AMP FUSE
70 AMP FUSE
8 AMP FUSE
8/3 WIRE
9 AMP FUSE
9/16 ROMEX STAPLE
B-CAPS BLUE
B-CAPS RED
BEAM CLAMPS
BUSS FNM-2 MIDGET FUSE
COIL KIT 240-480 SIEMENS
COIL KIT-SIEMENS
CORD 12-3 SJEOW 300V BLACK 12-3 300V BLACK CORD
GEAR OIL (GALLON)
GEN STATION, METAL HD, CMPLT, 1 HOLE
GROUND CLAMPS
GROUND RODS
HOA SWITCH
INSULATED LUGS
OVER LOAD RELAY 13-52 AMPS
OVER LOAD RELAY 25-100 AMPS
P&S 5269-X STR BLD CONN 2P 3W 15A 125V
P&S PS5266-XSTR BLD PLUG 3W 15A 125V
PUMP PANEL SIZE 2
PUMP PANEL SIZE 2, 13-52 AMPS
PUMP PANEL SIZE 3, 25-100 AMPS
PVC PIPE
STARTER SIZE 2
STARTER SIZE 3
WIRE LUGS
Electrician Item 2 Qty
*
Electrician Item 3
Please Select
#1 STARTER
#12 THHN WIRE
#3 STARTER
#4 WIRE
#6 WIRE
#8 WIRE
1 1/2 X 3/4 REDUCING BUSHING
1 1/2 X 3/4 REDUCING WASHER
1 1/4 X 3/4 REDUCING BUSHING
1 1/4 X 3/4 REDUCING WASHER
1 X 3/4 REDUCING BUSHING
1 X 3/4 REDUCING WASHER
10 AMP FUSE
10/3 WIRE
12 AMP FUSE
14/3 WIRE
15 AMP FUSE
17 1/2 LINE FUSE
17.5 AMP FUSE
2 1/2 X 3/4 REDUCING BUSHING
2 X 1/2 REDUCING BUSHING
2 X 3/4 REDUCING BUSHING
2 X 3/4 REDUCING WASHER
2" GROUND CLAMP
20 AMP FUSE
25 AMP FUSE
25’ CORD
3 AMP FUSE LINK
3/4 ROMEX CONNECTOR
3/8 ROMEX CONNECTOR
30 AMP DISCONNECT
30 AMP FUSE
30 AMP FUSE T
35 AMP FUSE
4" SQ BX COVER, STL, FLAT
40 AMP FUSE
45 AMP FUSE
480V 5A
4X4 LUMBER
5 AMP FUSE
5 H.P. INVENTORY MOTOR
5/8 GROUND RODS
50 AMP FUSE
50VA 220-480X110-120 CCT
6/3 WIRE
60 AMP DISCONNECT
60 AMP FUSE
7 AMP FUSE
70 AMP FUSE
8 AMP FUSE
8/3 WIRE
9 AMP FUSE
9/16 ROMEX STAPLE
B-CAPS BLUE
B-CAPS RED
BEAM CLAMPS
BUSS FNM-2 MIDGET FUSE
COIL KIT 240-480 SIEMENS
COIL KIT-SIEMENS
CORD 12-3 SJEOW 300V BLACK 12-3 300V BLACK CORD
GEAR OIL (GALLON)
GEN STATION, METAL HD, CMPLT, 1 HOLE
GROUND CLAMPS
GROUND RODS
HOA SWITCH
INSULATED LUGS
OVER LOAD RELAY 13-52 AMPS
OVER LOAD RELAY 25-100 AMPS
P&S 5269-X STR BLD CONN 2P 3W 15A 125V
P&S PS5266-XSTR BLD PLUG 3W 15A 125V
PUMP PANEL SIZE 2
PUMP PANEL SIZE 2, 13-52 AMPS
PUMP PANEL SIZE 3, 25-100 AMPS
PVC PIPE
STARTER SIZE 2
STARTER SIZE 3
WIRE LUGS
Electrician Item 3 Qty
*
Electrician Item 4
Please Select
#1 STARTER
#12 THHN WIRE
#3 STARTER
#4 WIRE
#6 WIRE
#8 WIRE
1 1/2 X 3/4 REDUCING BUSHING
1 1/2 X 3/4 REDUCING WASHER
1 1/4 X 3/4 REDUCING BUSHING
1 1/4 X 3/4 REDUCING WASHER
1 X 3/4 REDUCING BUSHING
1 X 3/4 REDUCING WASHER
10 AMP FUSE
10/3 WIRE
12 AMP FUSE
14/3 WIRE
15 AMP FUSE
17 1/2 LINE FUSE
17.5 AMP FUSE
2 1/2 X 3/4 REDUCING BUSHING
2 X 1/2 REDUCING BUSHING
2 X 3/4 REDUCING BUSHING
2 X 3/4 REDUCING WASHER
2" GROUND CLAMP
20 AMP FUSE
25 AMP FUSE
25’ CORD
3 AMP FUSE LINK
3/4 ROMEX CONNECTOR
3/8 ROMEX CONNECTOR
30 AMP DISCONNECT
30 AMP FUSE
30 AMP FUSE T
35 AMP FUSE
4" SQ BX COVER, STL, FLAT
40 AMP FUSE
45 AMP FUSE
480V 5A
4X4 LUMBER
5 AMP FUSE
5 H.P. INVENTORY MOTOR
5/8 GROUND RODS
50 AMP FUSE
50VA 220-480X110-120 CCT
6/3 WIRE
60 AMP DISCONNECT
60 AMP FUSE
7 AMP FUSE
70 AMP FUSE
8 AMP FUSE
8/3 WIRE
9 AMP FUSE
9/16 ROMEX STAPLE
B-CAPS BLUE
B-CAPS RED
BEAM CLAMPS
BUSS FNM-2 MIDGET FUSE
COIL KIT 240-480 SIEMENS
COIL KIT-SIEMENS
CORD 12-3 SJEOW 300V BLACK 12-3 300V BLACK CORD
GEAR OIL (GALLON)
GEN STATION, METAL HD, CMPLT, 1 HOLE
GROUND CLAMPS
GROUND RODS
HOA SWITCH
INSULATED LUGS
OVER LOAD RELAY 13-52 AMPS
OVER LOAD RELAY 25-100 AMPS
P&S 5269-X STR BLD CONN 2P 3W 15A 125V
P&S PS5266-XSTR BLD PLUG 3W 15A 125V
PUMP PANEL SIZE 2
PUMP PANEL SIZE 2, 13-52 AMPS
PUMP PANEL SIZE 3, 25-100 AMPS
PVC PIPE
STARTER SIZE 2
STARTER SIZE 3
WIRE LUGS
Electrician Item 4 Qty
*
Electrician Item 5
Please Select
#1 STARTER
#12 THHN WIRE
#3 STARTER
#4 WIRE
#6 WIRE
#8 WIRE
1 1/2 X 3/4 REDUCING BUSHING
1 1/2 X 3/4 REDUCING WASHER
1 1/4 X 3/4 REDUCING BUSHING
1 1/4 X 3/4 REDUCING WASHER
1 X 3/4 REDUCING BUSHING
1 X 3/4 REDUCING WASHER
10 AMP FUSE
10/3 WIRE
12 AMP FUSE
14/3 WIRE
15 AMP FUSE
17 1/2 LINE FUSE
17.5 AMP FUSE
2 1/2 X 3/4 REDUCING BUSHING
2 X 1/2 REDUCING BUSHING
2 X 3/4 REDUCING BUSHING
2 X 3/4 REDUCING WASHER
2" GROUND CLAMP
20 AMP FUSE
25 AMP FUSE
25’ CORD
3 AMP FUSE LINK
3/4 ROMEX CONNECTOR
3/8 ROMEX CONNECTOR
30 AMP DISCONNECT
30 AMP FUSE
30 AMP FUSE T
35 AMP FUSE
4" SQ BX COVER, STL, FLAT
40 AMP FUSE
45 AMP FUSE
480V 5A
4X4 LUMBER
5 AMP FUSE
5 H.P. INVENTORY MOTOR
5/8 GROUND RODS
50 AMP FUSE
50VA 220-480X110-120 CCT
6/3 WIRE
60 AMP DISCONNECT
60 AMP FUSE
7 AMP FUSE
70 AMP FUSE
8 AMP FUSE
8/3 WIRE
9 AMP FUSE
9/16 ROMEX STAPLE
B-CAPS BLUE
B-CAPS RED
BEAM CLAMPS
BUSS FNM-2 MIDGET FUSE
COIL KIT 240-480 SIEMENS
COIL KIT-SIEMENS
CORD 12-3 SJEOW 300V BLACK 12-3 300V BLACK CORD
GEAR OIL (GALLON)
GEN STATION, METAL HD, CMPLT, 1 HOLE
GROUND CLAMPS
GROUND RODS
HOA SWITCH
INSULATED LUGS
OVER LOAD RELAY 13-52 AMPS
OVER LOAD RELAY 25-100 AMPS
P&S 5269-X STR BLD CONN 2P 3W 15A 125V
P&S PS5266-XSTR BLD PLUG 3W 15A 125V
PUMP PANEL SIZE 2
PUMP PANEL SIZE 2, 13-52 AMPS
PUMP PANEL SIZE 3, 25-100 AMPS
PVC PIPE
STARTER SIZE 2
STARTER SIZE 3
WIRE LUGS
Electrician Item 5 Qty
*
Electrician Item Need More?
*
Yes
No
Electrician Item 6
Please Select
#1 STARTER
#12 THHN WIRE
#3 STARTER
#4 WIRE
#6 WIRE
#8 WIRE
1 1/2 X 3/4 REDUCING BUSHING
1 1/2 X 3/4 REDUCING WASHER
1 1/4 X 3/4 REDUCING BUSHING
1 1/4 X 3/4 REDUCING WASHER
1 X 3/4 REDUCING BUSHING
1 X 3/4 REDUCING WASHER
10 AMP FUSE
10/3 WIRE
12 AMP FUSE
14/3 WIRE
15 AMP FUSE
17 1/2 LINE FUSE
17.5 AMP FUSE
2 1/2 X 3/4 REDUCING BUSHING
2 X 1/2 REDUCING BUSHING
2 X 3/4 REDUCING BUSHING
2 X 3/4 REDUCING WASHER
2" GROUND CLAMP
20 AMP FUSE
25 AMP FUSE
25’ CORD
3 AMP FUSE LINK
3/4 ROMEX CONNECTOR
3/8 ROMEX CONNECTOR
30 AMP DISCONNECT
30 AMP FUSE
30 AMP FUSE T
35 AMP FUSE
4" SQ BX COVER, STL, FLAT
40 AMP FUSE
45 AMP FUSE
480V 5A
4X4 LUMBER
5 AMP FUSE
5 H.P. INVENTORY MOTOR
5/8 GROUND RODS
50 AMP FUSE
50VA 220-480X110-120 CCT
6/3 WIRE
60 AMP DISCONNECT
60 AMP FUSE
7 AMP FUSE
70 AMP FUSE
8 AMP FUSE
8/3 WIRE
9 AMP FUSE
9/16 ROMEX STAPLE
B-CAPS BLUE
B-CAPS RED
BEAM CLAMPS
BUSS FNM-2 MIDGET FUSE
COIL KIT 240-480 SIEMENS
COIL KIT-SIEMENS
CORD 12-3 SJEOW 300V BLACK 12-3 300V BLACK CORD
GEAR OIL (GALLON)
GEN STATION, METAL HD, CMPLT, 1 HOLE
GROUND CLAMPS
GROUND RODS
HOA SWITCH
INSULATED LUGS
OVER LOAD RELAY 13-52 AMPS
OVER LOAD RELAY 25-100 AMPS
P&S 5269-X STR BLD CONN 2P 3W 15A 125V
P&S PS5266-XSTR BLD PLUG 3W 15A 125V
PUMP PANEL SIZE 2
PUMP PANEL SIZE 2, 13-52 AMPS
PUMP PANEL SIZE 3, 25-100 AMPS
PVC PIPE
STARTER SIZE 2
STARTER SIZE 3
WIRE LUGS
Electrician Item 6 Qty
*
Electrician Item 7
Please Select
#1 STARTER
#12 THHN WIRE
#3 STARTER
#4 WIRE
#6 WIRE
#8 WIRE
1 1/2 X 3/4 REDUCING BUSHING
1 1/2 X 3/4 REDUCING WASHER
1 1/4 X 3/4 REDUCING BUSHING
1 1/4 X 3/4 REDUCING WASHER
1 X 3/4 REDUCING BUSHING
1 X 3/4 REDUCING WASHER
10 AMP FUSE
10/3 WIRE
12 AMP FUSE
14/3 WIRE
15 AMP FUSE
17 1/2 LINE FUSE
17.5 AMP FUSE
2 1/2 X 3/4 REDUCING BUSHING
2 X 1/2 REDUCING BUSHING
2 X 3/4 REDUCING BUSHING
2 X 3/4 REDUCING WASHER
2" GROUND CLAMP
20 AMP FUSE
25 AMP FUSE
25’ CORD
3 AMP FUSE LINK
3/4 ROMEX CONNECTOR
3/8 ROMEX CONNECTOR
30 AMP DISCONNECT
30 AMP FUSE
30 AMP FUSE T
35 AMP FUSE
4" SQ BX COVER, STL, FLAT
40 AMP FUSE
45 AMP FUSE
480V 5A
4X4 LUMBER
5 AMP FUSE
5 H.P. INVENTORY MOTOR
5/8 GROUND RODS
50 AMP FUSE
50VA 220-480X110-120 CCT
6/3 WIRE
60 AMP DISCONNECT
60 AMP FUSE
7 AMP FUSE
70 AMP FUSE
8 AMP FUSE
8/3 WIRE
9 AMP FUSE
9/16 ROMEX STAPLE
B-CAPS BLUE
B-CAPS RED
BEAM CLAMPS
BUSS FNM-2 MIDGET FUSE
COIL KIT 240-480 SIEMENS
COIL KIT-SIEMENS
CORD 12-3 SJEOW 300V BLACK 12-3 300V BLACK CORD
GEAR OIL (GALLON)
GEN STATION, METAL HD, CMPLT, 1 HOLE
GROUND CLAMPS
GROUND RODS
HOA SWITCH
INSULATED LUGS
OVER LOAD RELAY 13-52 AMPS
OVER LOAD RELAY 25-100 AMPS
P&S 5269-X STR BLD CONN 2P 3W 15A 125V
P&S PS5266-XSTR BLD PLUG 3W 15A 125V
PUMP PANEL SIZE 2
PUMP PANEL SIZE 2, 13-52 AMPS
PUMP PANEL SIZE 3, 25-100 AMPS
PVC PIPE
STARTER SIZE 2
STARTER SIZE 3
WIRE LUGS
Electrician Item 7 Qty
*
Electrician Item 8
Please Select
#1 STARTER
#12 THHN WIRE
#3 STARTER
#4 WIRE
#6 WIRE
#8 WIRE
1 1/2 X 3/4 REDUCING BUSHING
1 1/2 X 3/4 REDUCING WASHER
1 1/4 X 3/4 REDUCING BUSHING
1 1/4 X 3/4 REDUCING WASHER
1 X 3/4 REDUCING BUSHING
1 X 3/4 REDUCING WASHER
10 AMP FUSE
10/3 WIRE
12 AMP FUSE
14/3 WIRE
15 AMP FUSE
17 1/2 LINE FUSE
17.5 AMP FUSE
2 1/2 X 3/4 REDUCING BUSHING
2 X 1/2 REDUCING BUSHING
2 X 3/4 REDUCING BUSHING
2 X 3/4 REDUCING WASHER
2" GROUND CLAMP
20 AMP FUSE
25 AMP FUSE
25’ CORD
3 AMP FUSE LINK
3/4 ROMEX CONNECTOR
3/8 ROMEX CONNECTOR
30 AMP DISCONNECT
30 AMP FUSE
30 AMP FUSE T
35 AMP FUSE
4" SQ BX COVER, STL, FLAT
40 AMP FUSE
45 AMP FUSE
480V 5A
4X4 LUMBER
5 AMP FUSE
5 H.P. INVENTORY MOTOR
5/8 GROUND RODS
50 AMP FUSE
50VA 220-480X110-120 CCT
6/3 WIRE
60 AMP DISCONNECT
60 AMP FUSE
7 AMP FUSE
70 AMP FUSE
8 AMP FUSE
8/3 WIRE
9 AMP FUSE
9/16 ROMEX STAPLE
B-CAPS BLUE
B-CAPS RED
BEAM CLAMPS
BUSS FNM-2 MIDGET FUSE
COIL KIT 240-480 SIEMENS
COIL KIT-SIEMENS
CORD 12-3 SJEOW 300V BLACK 12-3 300V BLACK CORD
GEAR OIL (GALLON)
GEN STATION, METAL HD, CMPLT, 1 HOLE
GROUND CLAMPS
GROUND RODS
HOA SWITCH
INSULATED LUGS
OVER LOAD RELAY 13-52 AMPS
OVER LOAD RELAY 25-100 AMPS
P&S 5269-X STR BLD CONN 2P 3W 15A 125V
P&S PS5266-XSTR BLD PLUG 3W 15A 125V
PUMP PANEL SIZE 2
PUMP PANEL SIZE 2, 13-52 AMPS
PUMP PANEL SIZE 3, 25-100 AMPS
PVC PIPE
STARTER SIZE 2
STARTER SIZE 3
WIRE LUGS
Electrician Item 8 Qty
*
Electrician Item 9
Please Select
#1 STARTER
#12 THHN WIRE
#3 STARTER
#4 WIRE
#6 WIRE
#8 WIRE
1 1/2 X 3/4 REDUCING BUSHING
1 1/2 X 3/4 REDUCING WASHER
1 1/4 X 3/4 REDUCING BUSHING
1 1/4 X 3/4 REDUCING WASHER
1 X 3/4 REDUCING BUSHING
1 X 3/4 REDUCING WASHER
10 AMP FUSE
10/3 WIRE
12 AMP FUSE
14/3 WIRE
15 AMP FUSE
17 1/2 LINE FUSE
17.5 AMP FUSE
2 1/2 X 3/4 REDUCING BUSHING
2 X 1/2 REDUCING BUSHING
2 X 3/4 REDUCING BUSHING
2 X 3/4 REDUCING WASHER
2" GROUND CLAMP
20 AMP FUSE
25 AMP FUSE
25’ CORD
3 AMP FUSE LINK
3/4 ROMEX CONNECTOR
3/8 ROMEX CONNECTOR
30 AMP DISCONNECT
30 AMP FUSE
30 AMP FUSE T
35 AMP FUSE
4" SQ BX COVER, STL, FLAT
40 AMP FUSE
45 AMP FUSE
480V 5A
4X4 LUMBER
5 AMP FUSE
5 H.P. INVENTORY MOTOR
5/8 GROUND RODS
50 AMP FUSE
50VA 220-480X110-120 CCT
6/3 WIRE
60 AMP DISCONNECT
60 AMP FUSE
7 AMP FUSE
70 AMP FUSE
8 AMP FUSE
8/3 WIRE
9 AMP FUSE
9/16 ROMEX STAPLE
B-CAPS BLUE
B-CAPS RED
BEAM CLAMPS
BUSS FNM-2 MIDGET FUSE
COIL KIT 240-480 SIEMENS
COIL KIT-SIEMENS
CORD 12-3 SJEOW 300V BLACK 12-3 300V BLACK CORD
GEAR OIL (GALLON)
GEN STATION, METAL HD, CMPLT, 1 HOLE
GROUND CLAMPS
GROUND RODS
HOA SWITCH
INSULATED LUGS
OVER LOAD RELAY 13-52 AMPS
OVER LOAD RELAY 25-100 AMPS
P&S 5269-X STR BLD CONN 2P 3W 15A 125V
P&S PS5266-XSTR BLD PLUG 3W 15A 125V
PUMP PANEL SIZE 2
PUMP PANEL SIZE 2, 13-52 AMPS
PUMP PANEL SIZE 3, 25-100 AMPS
PVC PIPE
STARTER SIZE 2
STARTER SIZE 3
WIRE LUGS
Electrician Item 9 Qty
*
Electrician Item 10
Please Select
#1 STARTER
#12 THHN WIRE
#3 STARTER
#4 WIRE
#6 WIRE
#8 WIRE
1 1/2 X 3/4 REDUCING BUSHING
1 1/2 X 3/4 REDUCING WASHER
1 1/4 X 3/4 REDUCING BUSHING
1 1/4 X 3/4 REDUCING WASHER
1 X 3/4 REDUCING BUSHING
1 X 3/4 REDUCING WASHER
10 AMP FUSE
10/3 WIRE
12 AMP FUSE
14/3 WIRE
15 AMP FUSE
17 1/2 LINE FUSE
17.5 AMP FUSE
2 1/2 X 3/4 REDUCING BUSHING
2 X 1/2 REDUCING BUSHING
2 X 3/4 REDUCING BUSHING
2 X 3/4 REDUCING WASHER
2" GROUND CLAMP
20 AMP FUSE
25 AMP FUSE
25’ CORD
3 AMP FUSE LINK
3/4 ROMEX CONNECTOR
3/8 ROMEX CONNECTOR
30 AMP DISCONNECT
30 AMP FUSE
30 AMP FUSE T
35 AMP FUSE
4" SQ BX COVER, STL, FLAT
40 AMP FUSE
45 AMP FUSE
480V 5A
4X4 LUMBER
5 AMP FUSE
5 H.P. INVENTORY MOTOR
5/8 GROUND RODS
50 AMP FUSE
50VA 220-480X110-120 CCT
6/3 WIRE
60 AMP DISCONNECT
60 AMP FUSE
7 AMP FUSE
70 AMP FUSE
8 AMP FUSE
8/3 WIRE
9 AMP FUSE
9/16 ROMEX STAPLE
B-CAPS BLUE
B-CAPS RED
BEAM CLAMPS
BUSS FNM-2 MIDGET FUSE
COIL KIT 240-480 SIEMENS
COIL KIT-SIEMENS
CORD 12-3 SJEOW 300V BLACK 12-3 300V BLACK CORD
GEAR OIL (GALLON)
GEN STATION, METAL HD, CMPLT, 1 HOLE
GROUND CLAMPS
GROUND RODS
HOA SWITCH
INSULATED LUGS
OVER LOAD RELAY 13-52 AMPS
OVER LOAD RELAY 25-100 AMPS
P&S 5269-X STR BLD CONN 2P 3W 15A 125V
P&S PS5266-XSTR BLD PLUG 3W 15A 125V
PUMP PANEL SIZE 2
PUMP PANEL SIZE 2, 13-52 AMPS
PUMP PANEL SIZE 3, 25-100 AMPS
PVC PIPE
STARTER SIZE 2
STARTER SIZE 3
WIRE LUGS
Electrician Item 10 Qty
*
Grease Trailer Inventory Used?
*
Yes
No
Grease Trailer Item 1
Please Select
3/4 REPLACEMENT HOSE
BOLT
FITTING/NUT
GREASE (CASE)
GREASE ZERT
Grease Trailer Qty 1
*
Grease Trailer Item 2
Please Select
3/4 REPLACEMENT HOSE
BOLT
FITTING/NUT
GREASE (CASE)
GREASE ZERT
Grease Trailer Qty 2
*
Grease Trailer Item 3
Please Select
3/4 REPLACEMENT HOSE
BOLT
FITTING/NUT
GREASE (CASE)
GREASE ZERT
Grease Trailer Qty 3
*
Grease Trailer Item 4
Please Select
3/4 REPLACEMENT HOSE
BOLT
FITTING/NUT
GREASE (CASE)
GREASE ZERT
Grease Trailer Qty 4
*
Grease Trailer Item 5
Please Select
3/4 REPLACEMENT HOSE
BOLT
FITTING/NUT
GREASE (CASE)
GREASE ZERT
Grease Trailer Qty 5
*
Equipment Transfered?
*
Yes
No
Transfered From
*
Transfered To
*
Pumping Unit Transfer
*
Equipment 1
Please Select
Casing 4 1/2-New (Ft)
Casing 4 1/2-Used (Ft)
Casing 5 1/2-New (Ft)
Casing 5 1/2-Used (Ft)
Motor 1.5 HP
Motor 10 HP
Motor 15 HP
Motor 2 HP
Motor 20 HP
Motor 25 HP
Motor 3 HP
Motor 30 HP
Motor 40 HP
Motor 5 HP
Motor 50 HP
Motor 60 HP
Motor 7.5 HP
Motor 75 HP
Oil Tank 150 BBL
Oil Tank 210 BBL
Oil Tank 300 BBL
Poly Pipe 2" (Ft)
Poly Pipe 3" (Ft)
Rods 1"-Junk
Rods 1"-New
Rods 1"-Used
Rods 3/4"-Junk
Rods 3/4"-New
Rods 3/4"-Used
Rods 5/8"-Junk
Rods 5/8"-New
Rods 5/8"-Used
Rods 7/8"-Junk
Rods 7/8"-New
Rods 7/8"-Used
Seperator 36 x 10 Coated
Surface 8 5/8 (Ft)
Tubing 2 3/8-Junk
Tubing 2 3/8-New
Tubing 2 3/8-Used
Tubing 2 7/8-Junk
Tubing 2 7/8-New
Tubing 2 7/8-Used
Tubing; 2 3/8-New Plastic Coated
Tubing; 2 3/8-Used Plastic Coated
Wellhead Assembly 4 1/2
Wellhead Assembly 5 1/2
ET 1 Qty
Equipment 2
Please Select
Casing 4 1/2-New (Ft)
Casing 4 1/2-Used (Ft)
Casing 5 1/2-New (Ft)
Casing 5 1/2-Used (Ft)
Motor 1.5 HP
Motor 10 HP
Motor 15 HP
Motor 2 HP
Motor 20 HP
Motor 25 HP
Motor 3 HP
Motor 30 HP
Motor 40 HP
Motor 5 HP
Motor 50 HP
Motor 60 HP
Motor 7.5 HP
Motor 75 HP
Oil Tank 150 BBL
Oil Tank 210 BBL
Oil Tank 300 BBL
Poly Pipe 2" (Ft)
Poly Pipe 3" (Ft)
Rods 1"-Junk
Rods 1"-New
Rods 1"-Used
Rods 3/4"-Junk
Rods 3/4"-New
Rods 3/4"-Used
Rods 5/8"-Junk
Rods 5/8"-New
Rods 5/8"-Used
Rods 7/8"-Junk
Rods 7/8"-New
Rods 7/8"-Used
Seperator 36 x 10 Coated
Surface 8 5/8 (Ft)
Tubing 2 3/8-Junk
Tubing 2 3/8-New
Tubing 2 3/8-Used
Tubing 2 7/8-Junk
Tubing 2 7/8-New
Tubing 2 7/8-Used
Tubing; 2 3/8-New Plastic Coated
Tubing; 2 3/8-Used Plastic Coated
Wellhead Assembly 4 1/2
Wellhead Assembly 5 1/2
ET 2 Qty
Equipment 3
Please Select
Casing 4 1/2-New (Ft)
Casing 4 1/2-Used (Ft)
Casing 5 1/2-New (Ft)
Casing 5 1/2-Used (Ft)
Motor 1.5 HP
Motor 10 HP
Motor 15 HP
Motor 2 HP
Motor 20 HP
Motor 25 HP
Motor 3 HP
Motor 30 HP
Motor 40 HP
Motor 5 HP
Motor 50 HP
Motor 60 HP
Motor 7.5 HP
Motor 75 HP
Oil Tank 150 BBL
Oil Tank 210 BBL
Oil Tank 300 BBL
Poly Pipe 2" (Ft)
Poly Pipe 3" (Ft)
Rods 1"-Junk
Rods 1"-New
Rods 1"-Used
Rods 3/4"-Junk
Rods 3/4"-New
Rods 3/4"-Used
Rods 5/8"-Junk
Rods 5/8"-New
Rods 5/8"-Used
Rods 7/8"-Junk
Rods 7/8"-New
Rods 7/8"-Used
Seperator 36 x 10 Coated
Surface 8 5/8 (Ft)
Tubing 2 3/8-Junk
Tubing 2 3/8-New
Tubing 2 3/8-Used
Tubing 2 7/8-Junk
Tubing 2 7/8-New
Tubing 2 7/8-Used
Tubing; 2 3/8-New Plastic Coated
Tubing; 2 3/8-Used Plastic Coated
Wellhead Assembly 4 1/2
Wellhead Assembly 5 1/2
ET 3 Qty
Equipment 4
Please Select
Casing 4 1/2-New (Ft)
Casing 4 1/2-Used (Ft)
Casing 5 1/2-New (Ft)
Casing 5 1/2-Used (Ft)
Motor 1.5 HP
Motor 10 HP
Motor 15 HP
Motor 2 HP
Motor 20 HP
Motor 25 HP
Motor 3 HP
Motor 30 HP
Motor 40 HP
Motor 5 HP
Motor 50 HP
Motor 60 HP
Motor 7.5 HP
Motor 75 HP
Oil Tank 150 BBL
Oil Tank 210 BBL
Oil Tank 300 BBL
Poly Pipe 2" (Ft)
Poly Pipe 3" (Ft)
Rods 1"-Junk
Rods 1"-New
Rods 1"-Used
Rods 3/4"-Junk
Rods 3/4"-New
Rods 3/4"-Used
Rods 5/8"-Junk
Rods 5/8"-New
Rods 5/8"-Used
Rods 7/8"-Junk
Rods 7/8"-New
Rods 7/8"-Used
Seperator 36 x 10 Coated
Surface 8 5/8 (Ft)
Tubing 2 3/8-Junk
Tubing 2 3/8-New
Tubing 2 3/8-Used
Tubing 2 7/8-Junk
Tubing 2 7/8-New
Tubing 2 7/8-Used
Tubing; 2 3/8-New Plastic Coated
Tubing; 2 3/8-Used Plastic Coated
Wellhead Assembly 4 1/2
Wellhead Assembly 5 1/2
ET 4 Qty
Equipment 5
Please Select
Casing 4 1/2-New (Ft)
Casing 4 1/2-Used (Ft)
Casing 5 1/2-New (Ft)
Casing 5 1/2-Used (Ft)
Motor 1.5 HP
Motor 10 HP
Motor 15 HP
Motor 2 HP
Motor 20 HP
Motor 25 HP
Motor 3 HP
Motor 30 HP
Motor 40 HP
Motor 5 HP
Motor 50 HP
Motor 60 HP
Motor 7.5 HP
Motor 75 HP
Oil Tank 150 BBL
Oil Tank 210 BBL
Oil Tank 300 BBL
Poly Pipe 2" (Ft)
Poly Pipe 3" (Ft)
Rods 1"-Junk
Rods 1"-New
Rods 1"-Used
Rods 3/4"-Junk
Rods 3/4"-New
Rods 3/4"-Used
Rods 5/8"-Junk
Rods 5/8"-New
Rods 5/8"-Used
Rods 7/8"-Junk
Rods 7/8"-New
Rods 7/8"-Used
Seperator 36 x 10 Coated
Surface 8 5/8 (Ft)
Tubing 2 3/8-Junk
Tubing 2 3/8-New
Tubing 2 3/8-Used
Tubing 2 7/8-Junk
Tubing 2 7/8-New
Tubing 2 7/8-Used
Tubing; 2 3/8-New Plastic Coated
Tubing; 2 3/8-Used Plastic Coated
Wellhead Assembly 4 1/2
Wellhead Assembly 5 1/2
ET 5 Qty
Equipment Transfered Other (Not in List)
Yes
No
Equipment 6
Et 6 Qty
Equipment 6 Value
Equipment 7
ET 7 Qty
Equipment 7 Value
Equipment 8
ET 8 Qty
Equipment 8 Value
Equipment 9
ET 9 Qty
Equipment 9 Value
Check Fluid Levels
Yes
No
Fluid Levels:
Inspect Interior
Yes
No
Interior
Inspect Exterior
Yes
No
Exterior
Inspect for Leaks
Yes
No
Leaks
Inspect Condition
Yes
No
Condition
Multiple Vendors?
Yes
No
Vendor 1
*
Vendor 1 Item 1 Description
*
Vendor 1 Item 1 Part of Well/Lease
Vendor 1 Item 1 Code
*
Vendor 1 Item 1 Qty
*
Vendor 1 Item 2 Description
Venfor 1 Item 2 Part of Well/Lease
Vendor 1 Item 2 Code
*
Vendor 1 Item 2 Qty
*
Vendor 1 Item 3 Size/Type
Vendor 1 Item 3 Part of Well/Lease
Vendor 1 Item 3 Code
*
Vendor 1 Item 3 Qty
*
Vendor 1 Item 4 Size/Type
Vendor 1 Item 4 Part of Well/Lease
Vendor 1 Item 4 Code
*
Vendor 1 Item 4 Qty
*
Vendor 1 Item 5 Size/Type
Vendor 1 Item 5 Part of Well/Lease
Vendor 1 Item 5 Code
*
Vendor 1 Item 5 Qty
*
Vendor 1 Item 6 Size/Type
Vendor 1 Item 6 Part of Well/Lease
Vendor 1 Item 6 Code
*
Vendor 1 Item 6 Qty
*
Vendor 1 Item 7 Size/Type
Vendor 1 Item 7 Part of Well/Lease
Vendor 1 Item 7 Code
*
Vendor 1 Item 7 Qty
*
Vendor 1 Item 8 Size/Type
Vendor 1 Item 8 Part of Well/Lease
Vendor 1 Item 8 Code
*
Vendor 1 Item 8 Qty
*
Vendor 1 Item 9 Size/Type
Vendor 1 Item 9 Part of Well/Lease
Vendor 1 Item 9 Code
*
Vendor 1 Item 9 Qty
*
Vendor 1 Item 10 Size/Type
Vendor 1 Item 10 Part of Well/Lease
Vendor 1 Item 10 Code
*
Vendor 1 Item 10 Qty
*
Vendor 2
*
Vendor 2 Item 1 Size/Type
Vendor 2 Item 1 Part of Well/Lease
Vendor 2 Item 1 Code
*
Vendor 2 Item 1 Qty
*
Vendor 2 Item 2 Size/Type
Vendor 2 Item 2 Part of Well/Lease
Vendor 2 Item 2 Code
*
Vendor 2 Item 2 Qty
*
Vendor 2 Item 3 Size/Type
Vendor 2 Item 3 Part of Well/Lease
Vendor 2 Item 3 Code
*
Vendor 2 Item 3 Qty
*
Vendor 2 Item 4 Size/Type
Vendor 2 Item 4 Part of Well/Lease
Vendor 2 Item 4 Code
*
Vendor 2 Item 4 Qty
*
Vendor 2 Item 5 Size/Type
Vendor 2 Item 5 Part of Well/Lease
Vendor 2 Item 5 Code
*
Vendor 2 Item 5 Qty
*
Vendor 2 Item 6 Size/Type
Vendor 2 Item 6 Part of Well/Lease
Vendor 2 Item 6 Code
*
Vendor 2 Item 6 Qty
*
Vendor 2 Item 7 Size/Type
Vendor 2 Item 7 Part of Well/Lease
Vendor 2 Item 7 Code
*
Vendor 2 Item 7 Qty
*
Vendor 2 Item 8 Size/Type
Vendor 2 Item 8 Part of Well/Lease
Vendor 2 Item 8 Code
*
Vendor 2 Item 8 Qty
*
Vendor 2 Item 9 Size/Type
Vendor 2 Item 9 Part of Well/Lease
Vendor 2 Item 9 Code
*
Vendor 2 Item 9 Qty
*
Vendor 2 Item 10 Size/Type
Vendor 2 Item 10 Part of Well/Lease
Vendor 2 Item 10 Code
*
Vendor 2 Item 10 Qty
*
Vendor 3
Vendor 3 Item 1 Size/Type
Vendor 3 Item 1 Part of Well/Lease
Vendor 3 Item 1 Code
*
Vendor 3 Item 1 Qty
*
Vendor 3 Item 2 Size/Type
Vendor 3 Item 2 Part of Well/Lease
Vendor 3 Item 2 Code
*
Vendor 3 Item 2 Qty
*
Vendor 3 Item 3 Size/Type
Vendor 3 Item 3 Part of Well/Lease
Vendor 3 Item 3 Code
*
Vendor 3 Item 3 Qty
*
Vendor 3 Item 4 Size/Type
Vendor 3 Item 4 Part of Well/Lease
Vendor 3 Item 4 Code
*
Vendor 3 Item 4 Qty
*
Vendor 3 Item 5 Size/Type
Vendor 3 Item 5 Part of Well/Lease
Vendor 3 Item 5 Code
*
Vendor 3 Item 5 Qty
*
Vendor 3 Item 6 Size/Type
Vendor 3 Item 6 Part of Well/Lease
Vendor 3 Item 6 Code
*
Vendor 3 Item 6 Qty
*
Vendor 3 Item 7 Size/Type
Vendor 3 Item 7 Part of Well/Lease
Vendor 3 Item 7 Code
*
Vendor 3 Item 7 Qty
*
Vendor 3 Item 8 Size/Type
Vendor 3 Item 8 Part of Well/Lease
Vendor 3 Item 8 Code
*
Vendor 3 Item 8 Qty
*
Vendor 3 Item 9 Size/Type
Vendor 3 Item 9 Part of Well/Lease
Vendor 3 Item 9 Code
*
Vendor 3 Item 9 Qty
*
Vendor 3 Item 10 Size/Type
Vendor 3 Item 10 Part of Well/Lease
Vendor 3 Item 10 Code
*
Vendor 3 Item 10 Qty
*
Mileage
*
Purchase Order Comments
Comments
Comments
Employee Email
*
Submit
Manager Approval
Manager Approval
Yes Approved
Not Approved
Signature
Manager Comments
Submit
Office Comments
PO Coding Checked?
*
Yes
No
Reviewer:
*
Office Comments
Email To:
Attachment:
Should be Empty: