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

DEP Form Oil&Gas16 is a Florida Department of Environmental Protection form also known as the "Notice Of Plugging Completion And Site Restoration". The latest edition of the form was released in March 1, 1998 and is available for digital filing.

Download an up-to-date DEP Form Oil&Gas16 in PDF-format down below or look it up on the Florida Department of Environmental Protection Forms website.

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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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