DEP Oil&Gas Form 16 "Notice of Plugging Completion and Site Restoration" - Florida

What Is DEP Oil&Gas Form 16?

This is a legal form that was released by the Florida Department of Environmental Protection - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 1998;
  • The latest edition provided by the Florida Department of Environmental Protection;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DEP Oil&Gas Form 16 by clicking the link below or browse more documents and templates provided by the Florida Department of Environmental Protection.

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Download DEP Oil&Gas Form 16 "Notice of Plugging Completion and Site Restoration" - Florida

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Oil&Gas Form 16
Florida
NOTICE OF PLUGGING COMPLETION
Form Title:
AND SITE RESTORATION
Department of
Environmental Protection
Date Revised:
March, 1998
Incorporated by Reference in:
Section 62C-29, F.A.C.
Within 30 days of plugging the well, file this form with Florida Department of Environmental Protection, Oil and Gas Program, 2600
BlairStone Road, MS 3588, Tallahassee, Florida 32399-2400 (phone 850/245-8336). Email: OGP@dep.state.fl.us
Permit Number: ___________________
Operator: ______________________________________________________________
API Number: ______________________________
Well Name and Number: __________________________________________
Location _____________________________________________________ Section _________ Township ________ Range _______
Latitude _______________________________________________ Longitude ___________________________________________
Plugging Contractor/Rig Number: _______________________________________ Cementing Contractor: ____________________
Elevation: Ground _____________ KB ______________ DF ______________ DF Ht. _____________ Spud Date: _____________
TD _________________________ Date plugging was: Commenced ____________________ Completed ___________________
DESCRIBE PLUGGING AND SITE RESTORATION PROCEDURE:
Person in charge of Plugging: Name _____________________________________________________________________________
Company Address ____________________________________________________________________________
____________________________________________________________________________
Phone Number ___________________________ Fax Number ________________________
Oil&Gas Form 16
Florida
NOTICE OF PLUGGING COMPLETION
Form Title:
AND SITE RESTORATION
Department of
Environmental Protection
Date Revised:
March, 1998
Incorporated by Reference in:
Section 62C-29, F.A.C.
Within 30 days of plugging the well, file this form with Florida Department of Environmental Protection, Oil and Gas Program, 2600
BlairStone Road, MS 3588, Tallahassee, Florida 32399-2400 (phone 850/245-8336). Email: OGP@dep.state.fl.us
Permit Number: ___________________
Operator: ______________________________________________________________
API Number: ______________________________
Well Name and Number: __________________________________________
Location _____________________________________________________ Section _________ Township ________ Range _______
Latitude _______________________________________________ Longitude ___________________________________________
Plugging Contractor/Rig Number: _______________________________________ Cementing Contractor: ____________________
Elevation: Ground _____________ KB ______________ DF ______________ DF Ht. _____________ Spud Date: _____________
TD _________________________ Date plugging was: Commenced ____________________ Completed ___________________
DESCRIBE PLUGGING AND SITE RESTORATION PROCEDURE:
Person in charge of Plugging: Name _____________________________________________________________________________
Company Address ____________________________________________________________________________
____________________________________________________________________________
Phone Number ___________________________ Fax Number ________________________
======================================================================================================
OPERATOR’S STATEMENT
State:
_________________________
County: _________________________
I, _____________________________________________, am the _____________________________________________________
(Name)
(Title)
of _______________________________________________________ and attest to all information contained herein to be true and
correct.
Signature: ________________________________________
Date: ____________________________________________
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