section .0200 – administrative rules

15A NCAC 05H .0201      FORMS

(a)  An applicant or permittee shall use the following forms, as provided by the Department:

(1)           Form 1 – Financial Responsibility Ownership;

(2)           Form 2 – Oil or Gas Well Permit Application;

(3)           Form 3 – Well Construction Design;

(4)           Form 4 – Water Management Plan;

(5)           Form 5 – Waste Management Plan;

(6)           Form 6 – Well Site Reclamation Plan;

(7)           Form 7 – Irrevocable Letter of Standby Credit;

(8)           Form 8 – Surety Bond;

(9)           Form 9 – Assignment of Savings;

(10)         Form 10 – Cash Deposit;

(11)         Form 11 – Required Notifications to the Department;

(12)         Form 12 – Well Drilling Report;

(13)         Form 14 – Plugging and Abandonment;

(14)         Form 15 – Oil or Gas Well Status;

(15)         Form 16 – Mechanical Integrity Test Results;

(16)         Form 17 – Notification of Return of Oil or Gas Well to Active Status;

(17)         Form 18 – Well Stimulation Report;

(18)         Form 19 – Chemical Disclosure Report;

(19)         Form 20 – Confidential Information Claim;

(20)         Form 21 – Water Supply Investigation Request;

(21)         Form 22 – Water Supply Testing Report;

(22)         Form 23 – Annual Water Use Report;

(23)         Form 24 – Annual E & P Waste Management Report;

(24)         Form 25 – Pit Closure Report;

(25)         Form 26 – Spill and Release Report;

(26)         Form 27 – Site Investigation and Remediation Work Plan;

(27)         Form 28 – Monthly Production Report; and

(28)         Form 29 – Well Site Inspection Report.

(b)  The use of any forms other than those provided by the Department is prohibited.  These forms are available on the Division's Oil and Gas Program webpage at the following address: http://portal.ncdenr.org/web/lr/oilgas.

(c) All notice and forms required by the rules in this Subchapter to be submitted to the Department shall be made to: Oil & Gas Program, Division of Energy, Mineral, and Land Resources, 1612 Mail Service Center, Raleigh, NC 27699-1612 and a copy in .pdf form submitted to Oil&Gas@ncdenr.gov.  The phone number for the Division is 919-707-9220 and the fax number is 919-715-8801.

History Note:        Authority G.S. 113-391;

Eff. March 17, 2015.