Form ENG-15C "E&p Waste Unauthorized Discharge/Disposal Notification" - Louisiana

What Is Form ENG-15C?

This is a legal form that was released by the Louisiana Department of Natural Resources - a government authority operating within Louisiana. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on June 1, 2011;
  • The latest edition provided by the Louisiana Department of Natural Resources;
  • 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 printable version of Form ENG-15C by clicking the link below or browse more documents and templates provided by the Louisiana Department of Natural Resources.

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Download Form ENG-15C "E&p Waste Unauthorized Discharge/Disposal Notification" - Louisiana

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DNR/OFFICE OF CONSERVATION
For Office Use Only
(If Land Treatment/Burial Method Used)
ENGINEERING DIVISION
PIT ID# ___ ___ P ___ ___ ___ ___
ENG-15c
Status
Date
Reviewed by
Rev 6/11
(See Instruction Page)
TYPE OR PRINT
E&P WASTE UNAUTHORIZED DISCHARGE/DISPOSAL NOTIFICATION
PART I - GENERAL INFORMATION
         
         
Operator Name:
Operator Code:
         
Mailing Address:
         
         
         
         
Contact Name:
Phone:
(
)
-
         
Facility Identification:
Well Name & No.
         
         
Serial No.:
(Nearest Associated Well)
         
         
Field:
Field Code:
         
         
Parish:
Parish Code:
Location Description
Latitude
Longitude
Section
Township
Range
         
         
         
         
         
         
         
         
         
°
°
 
PART II - DISCHARGE INFORMATION
Discharge Date
Additional Comments:
         
         
Report Date
         
(See Back Page for Details)
Type and Volume (Check all that apply/Report vol. & units):
Area of Impact:
         
Length
Width
Ave. Depth
OIL
Volume:
 
 
 
ft.
ft.
ft.
         
SALTWATER
Volume:
         
OTHER
Volume:
Location of Discharge:
If other, Describe:
Latitude
Longitude
         
         
         
         
         
         
°
°
Total Volume Recovered:
Factors and/or Causes Resulting in the Accumulations or Discharge of E&P Waste (Attach additional sheet if necessary):
Action Taken to immediately Control/Contain Spill (Attach additional sheet if necessary):
         
Measures taken to prevent future spills:
         
PART III – CLEANUP METHOD(S)
Select Method(s) Utilized in Cleanup: (Check Method(s) used, record Volume and select appropriate Units)
Burial/Trenching (Must Submit Closure Data – See Instr. Page)
Volume:
Land Treatment (Must Submit Closure Data – See Instr. Page)
Volume:
Return to Production Facility
Volume:
Commercial Waste Facility (Must Submit Form UIC-28)
Volume:
Note: A list of approved offsite commercial waste facilities may be obtained from Injection & Mining Division by calling (225) 342-5515.
I attest that the cleanup in question was performed in accordance with LAC 43:XIX.311. If burial /trenching is
checked above, I also attest that the burial cell is at least five (5) feet above the seasonal high water table, and at
least five (5) feet below ground level and covered with native soil.
Print or Type Name
Date
Signature of Responsible Party
Submit to: DNR/OFFICE OF CONSERVATION, ENGINEERING DIVISION, P.O. BOX 94275, BATON ROUGE, LA 70804-9275
DNR/OFFICE OF CONSERVATION
For Office Use Only
(If Land Treatment/Burial Method Used)
ENGINEERING DIVISION
PIT ID# ___ ___ P ___ ___ ___ ___
ENG-15c
Status
Date
Reviewed by
Rev 6/11
(See Instruction Page)
TYPE OR PRINT
E&P WASTE UNAUTHORIZED DISCHARGE/DISPOSAL NOTIFICATION
PART I - GENERAL INFORMATION
         
         
Operator Name:
Operator Code:
         
Mailing Address:
         
         
         
         
Contact Name:
Phone:
(
)
-
         
Facility Identification:
Well Name & No.
         
         
Serial No.:
(Nearest Associated Well)
         
         
Field:
Field Code:
         
         
Parish:
Parish Code:
Location Description
Latitude
Longitude
Section
Township
Range
         
         
         
         
         
         
         
         
         
°
°
 
PART II - DISCHARGE INFORMATION
Discharge Date
Additional Comments:
         
         
Report Date
         
(See Back Page for Details)
Type and Volume (Check all that apply/Report vol. & units):
Area of Impact:
         
Length
Width
Ave. Depth
OIL
Volume:
 
 
 
ft.
ft.
ft.
         
SALTWATER
Volume:
         
OTHER
Volume:
Location of Discharge:
If other, Describe:
Latitude
Longitude
         
         
         
         
         
         
°
°
Total Volume Recovered:
Factors and/or Causes Resulting in the Accumulations or Discharge of E&P Waste (Attach additional sheet if necessary):
Action Taken to immediately Control/Contain Spill (Attach additional sheet if necessary):
         
Measures taken to prevent future spills:
         
PART III – CLEANUP METHOD(S)
Select Method(s) Utilized in Cleanup: (Check Method(s) used, record Volume and select appropriate Units)
Burial/Trenching (Must Submit Closure Data – See Instr. Page)
Volume:
Land Treatment (Must Submit Closure Data – See Instr. Page)
Volume:
Return to Production Facility
Volume:
Commercial Waste Facility (Must Submit Form UIC-28)
Volume:
Note: A list of approved offsite commercial waste facilities may be obtained from Injection & Mining Division by calling (225) 342-5515.
I attest that the cleanup in question was performed in accordance with LAC 43:XIX.311. If burial /trenching is
checked above, I also attest that the burial cell is at least five (5) feet above the seasonal high water table, and at
least five (5) feet below ground level and covered with native soil.
Print or Type Name
Date
Signature of Responsible Party
Submit to: DNR/OFFICE OF CONSERVATION, ENGINEERING DIVISION, P.O. BOX 94275, BATON ROUGE, LA 70804-9275