DEP Oil&Gas Form 3A "Notice of Change of Operator" - Florida

DEP Form Oil&Gas3A or the "Notice Of Change Of Operator" is a form issued by the Florida Department of Environmental Protection.

The form was last revised in March 1, 1998 and is available for digital filing. Download an up-to-date DEP Form Oil&Gas3A 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 3A "Notice of Change of Operator" - Florida

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Oil & Gas Form 3A
Florida
NOTICE OF CHANGE OF OPERATOR
Form Title:
Department of
Date Revised:
March, 1998
Environmental Protection
Incorporated by Reference in:
Section 62C-26.008, F.A.C.
File this form in triplicate with the Florida Department of Environmental Protection, Oil and Gas Program, 2600 Blair Stone Road, MS
OGP@dep.state.fl.us
3588, Tallahassee, Florida 32399-2400 (phone 850/245-8336). Email:
PURPOSE OF APPLICATION
a) Notice of change of name of present operator.
_________ (yes or no)
b) Notice of change of operator
_________ (yes or no)
Specify kind of well, status and field or area, as appropriate: _______________________________________________________________
CURRENT (Old)
Name:
_____________________________________________________________________________
OPERATOR
Address:
_____________________________________________________________________________
_____________________________________________________________________________
Phone:
_____________________________________ Fax: _____ _____________________________
FUTURE (New)
Name:
_____________________________________________________________________________
OPERATOR
Address:
_____________________________________________________________________________
_____________________________________________________________________________
Phone:
_____________________________________ Fax: __________________________________
WELL TO BE TRANSFERRED
Name & Number: _____________________________________________________________________
Permit Number: ______________________ Location: ______________________________________
____________________________________________________________________________________
________________________________________________________ (
Section, Section Calls, Township, Range)
New operator must provide acceptable security, before the transfer can be completed.
STATEMENT OF CURRENT (Old) OPERATOR
State:
______________________________________
County: ______________________________________
I, ___________________________________________________, am the _____________________________________________________
(Name)
(Title)
of ___________________________________________________________ and I hereby transfer operatorship or ownership of the above
(Company)
Described well (and concurrent responsibilities under Chapter 377, Florida Statutes, and Chapter 62C-25 through 30, Florida Administrative
Code) to the new operator or owner named below.
Signature: ___ ___________________________________________
Date: __________________________________________________
Oil & Gas Form 3A
Florida
NOTICE OF CHANGE OF OPERATOR
Form Title:
Department of
Date Revised:
March, 1998
Environmental Protection
Incorporated by Reference in:
Section 62C-26.008, F.A.C.
File this form in triplicate with the Florida Department of Environmental Protection, Oil and Gas Program, 2600 Blair Stone Road, MS
OGP@dep.state.fl.us
3588, Tallahassee, Florida 32399-2400 (phone 850/245-8336). Email:
PURPOSE OF APPLICATION
a) Notice of change of name of present operator.
_________ (yes or no)
b) Notice of change of operator
_________ (yes or no)
Specify kind of well, status and field or area, as appropriate: _______________________________________________________________
CURRENT (Old)
Name:
_____________________________________________________________________________
OPERATOR
Address:
_____________________________________________________________________________
_____________________________________________________________________________
Phone:
_____________________________________ Fax: _____ _____________________________
FUTURE (New)
Name:
_____________________________________________________________________________
OPERATOR
Address:
_____________________________________________________________________________
_____________________________________________________________________________
Phone:
_____________________________________ Fax: __________________________________
WELL TO BE TRANSFERRED
Name & Number: _____________________________________________________________________
Permit Number: ______________________ Location: ______________________________________
____________________________________________________________________________________
________________________________________________________ (
Section, Section Calls, Township, Range)
New operator must provide acceptable security, before the transfer can be completed.
STATEMENT OF CURRENT (Old) OPERATOR
State:
______________________________________
County: ______________________________________
I, ___________________________________________________, am the _____________________________________________________
(Name)
(Title)
of ___________________________________________________________ and I hereby transfer operatorship or ownership of the above
(Company)
Described well (and concurrent responsibilities under Chapter 377, Florida Statutes, and Chapter 62C-25 through 30, Florida Administrative
Code) to the new operator or owner named below.
Signature: ___ ___________________________________________
Date: __________________________________________________
STATEMENT OF FUTURE (New) OPERATOR
State:
______________________________________
County: _____________________________________
I, ___________________________________________________, am the _____________________________________________________
(Name)
(Title)
of ____________________________________________________________ and I hereby accept operatorship or ownership of the well (and
(Company)
concurrent responsibilities under Chapter 377, Florida Statutes, and Chapter 62C-25 through 30, Florida Administrative Code) described above
from the current (old) operator or owner named above.
Signature: ______________________________________________
Date: __________________________________________________
ACTION OF DEPARTMENT
Action: _
________________________
By: __________________________________________________________________
(Approved/Denied)
(Name)
(Title)
Date: _
_________________________
Signature:
____________________________________________________________
DEP 51-0031(16)
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