DEP Oil&Gas Form 10A "Monthly Injection Well Report" - Florida

DEP Form Oil&Gas10A or the "Monthly Injection Well Report" is a form issued by the Florida Department of Environmental Protection.

Download a PDF version of the DEP Form Oil&Gas10A down below or find it on the Florida Department of Environmental Protection Forms website.

ADVERTISEMENT

Download DEP Oil&Gas Form 10A "Monthly Injection Well Report" - Florida

687 times
Rate
(4.7 / 5) 34 votes
Oil&Gas Form 10A
Florida
MONTHLY INJECTION WELL REPORT
Form Title:
Department of
Date Revised:
March, 1998
Environmental Protection
Incorporated by Reference in:
Section
62C-28.004(1)
, F.A.C.
County:
Operator Field Office Phone:
Field:
Operator:
For the Month of
Year
WELL DATA
MONTHLY INJECTION
INSPECTION
Well Name and Number
Permit
Well
Days
Fluid
Casing
Tubing
Volume
Visual Inspect.
Gauge Calib.
Initial Injection
Last
Cumulative Volume
Number
Status
Oper.
Injected
Pressure
Pressure
Injected
(Yes/No)
(Yes/No)
Date
M I T
Injected to Date
Totals
File this report with the Florida Department of Environmental Protection, Oil and Gas Program, 2600 Blair Stone Road, MS 3588, Tallahassee, Florida 32399-2400 (phone 850/245-8336), Email:
OGP@dep.state.fl.us
within 30 days of the report period.
I,
am the
of
and attest that the information contained herein is
____________________________________________________,
______________________________________________
_____________________________________________________,
(Name)
(Title)
(Company)
true and correct.
Date __________________ Phone Number ____________________________ Signature _____________________________________________________
DEP 51-035(16)
Oil&Gas Form 10A
Florida
MONTHLY INJECTION WELL REPORT
Form Title:
Department of
Date Revised:
March, 1998
Environmental Protection
Incorporated by Reference in:
Section
62C-28.004(1)
, F.A.C.
County:
Operator Field Office Phone:
Field:
Operator:
For the Month of
Year
WELL DATA
MONTHLY INJECTION
INSPECTION
Well Name and Number
Permit
Well
Days
Fluid
Casing
Tubing
Volume
Visual Inspect.
Gauge Calib.
Initial Injection
Last
Cumulative Volume
Number
Status
Oper.
Injected
Pressure
Pressure
Injected
(Yes/No)
(Yes/No)
Date
M I T
Injected to Date
Totals
File this report with the Florida Department of Environmental Protection, Oil and Gas Program, 2600 Blair Stone Road, MS 3588, Tallahassee, Florida 32399-2400 (phone 850/245-8336), Email:
OGP@dep.state.fl.us
within 30 days of the report period.
I,
am the
of
and attest that the information contained herein is
____________________________________________________,
______________________________________________
_____________________________________________________,
(Name)
(Title)
(Company)
true and correct.
Date __________________ Phone Number ____________________________ Signature _____________________________________________________
DEP 51-035(16)
ADVERTISEMENT