Form MO780-2634 "Oil and Gas Transfer of Well(S) and/or Transfer of Injection Permit(S) - Geological Survey Program" - Missouri

What Is Form MO780-2634?

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

Form Details:

  • Released on April 1, 2018;
  • The latest edition provided by the Missouri 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 fillable version of Form MO780-2634 by clicking the link below or browse more documents and templates provided by the Missouri Department of Natural Resources.

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Download Form MO780-2634 "Oil and Gas Transfer of Well(S) and/or Transfer of Injection Permit(S) - Geological Survey Program" - Missouri

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MISSOURI DEPARTMENT OF NATURAL RESOURCES
GEOLOGICAL SURVEY PROGRAM
OIL AND GAS TRANSFER OF WELL(S) AND/OR
TRANSFER OF INJECTION PERMIT(S)
TRANSFEROR INFORMATION
NAME OF COMPANY, ORGANIZATION, OR INDIVIDUAL THAT DRILLS, MAINTAINS, OPERATES, OR CONTROLS OIL AND GAS
EMAIL ADDRESS
WELLS IN MISSOURI
MAILING ADDRESS
CITY
STATE
ZIP
PHYSICAL ADDRESS (IF DIFFERENT THAN ABOVE)
PRIMARY PHONE NUMBER WITH AREA CODE
OPERATOR LICENSE NUMBER
CONTACT NAME
TITLE
PRIMARY PHONE NUMBER WITH
EMAIL ADDRESS
AREA CODE
TRANSFEREE INFORMATION
NAME OF COMPANY, ORGANIZATION, OR INDIVIDUAL THAT DRILLS, MAINTAINS, OPERATES, OR CONTROLS OIL AND GAS
EMAIL ADDRESS
WELLS IN MISSOURI
MAILING ADDRESS
CITY
STATE
ZIP
PHYSICAL ADDRESS (IF DIFFERENT THAN ABOVE)
PRIMARY PHONE NUMBER WITH AREA CODE
OPERATOR LICENSE NUMBER
CONTACT NAME
TITLE
PRIMARY PHONE NUMBER WITH
EMAIL ADDRESS
AREA CODE
WELL TRANSFER INFORMATION (ATTACH A LIST IN THIS FORMAT IF NECESSARY)
Well transfer requirements and post well transfer requirements on back of form.
REQUESTED DATE OF WELL TRANSFER
*WELL TYPE CODE: OP (OIL PRODUCTION), GP (GAS PRODUCTION), ID (INJECTION DISPOSAL), IE (INJECTION EOR), O (OTHER)
**WELL STATUS CODE: AC (ACTIVE), UC (UNDER CONSTRUCTION), SI (SHUT-IN), AB (ABANDONED), O (OTHER)
API Number
Well Number
Well Type* Well Status** Well Latitude
Well Longitude
Production Unit (lease or surface unit name)
MO 780-2634 (04-18)
SEND COMPLETED FORM ALONG WITH REQUESTED INFORMATION TO: MISSOURI DEPARTMENT OF NATURAL RESOURCES,
MISSOURI GEOLOGICAL SURVEY, GEOLOGIC RESOURCES SECTION, PO BOX 250, ROLLA, MO 65402
PHONE: 573-368-2100 FAX: 573-368-2111 EMAIL:
oilandgas@dnr.mo.gov
MISSOURI DEPARTMENT OF NATURAL RESOURCES
GEOLOGICAL SURVEY PROGRAM
OIL AND GAS TRANSFER OF WELL(S) AND/OR
TRANSFER OF INJECTION PERMIT(S)
TRANSFEROR INFORMATION
NAME OF COMPANY, ORGANIZATION, OR INDIVIDUAL THAT DRILLS, MAINTAINS, OPERATES, OR CONTROLS OIL AND GAS
EMAIL ADDRESS
WELLS IN MISSOURI
MAILING ADDRESS
CITY
STATE
ZIP
PHYSICAL ADDRESS (IF DIFFERENT THAN ABOVE)
PRIMARY PHONE NUMBER WITH AREA CODE
OPERATOR LICENSE NUMBER
CONTACT NAME
TITLE
PRIMARY PHONE NUMBER WITH
EMAIL ADDRESS
AREA CODE
TRANSFEREE INFORMATION
NAME OF COMPANY, ORGANIZATION, OR INDIVIDUAL THAT DRILLS, MAINTAINS, OPERATES, OR CONTROLS OIL AND GAS
EMAIL ADDRESS
WELLS IN MISSOURI
MAILING ADDRESS
CITY
STATE
ZIP
PHYSICAL ADDRESS (IF DIFFERENT THAN ABOVE)
PRIMARY PHONE NUMBER WITH AREA CODE
OPERATOR LICENSE NUMBER
CONTACT NAME
TITLE
PRIMARY PHONE NUMBER WITH
EMAIL ADDRESS
AREA CODE
WELL TRANSFER INFORMATION (ATTACH A LIST IN THIS FORMAT IF NECESSARY)
Well transfer requirements and post well transfer requirements on back of form.
REQUESTED DATE OF WELL TRANSFER
*WELL TYPE CODE: OP (OIL PRODUCTION), GP (GAS PRODUCTION), ID (INJECTION DISPOSAL), IE (INJECTION EOR), O (OTHER)
**WELL STATUS CODE: AC (ACTIVE), UC (UNDER CONSTRUCTION), SI (SHUT-IN), AB (ABANDONED), O (OTHER)
API Number
Well Number
Well Type* Well Status** Well Latitude
Well Longitude
Production Unit (lease or surface unit name)
MO 780-2634 (04-18)
SEND COMPLETED FORM ALONG WITH REQUESTED INFORMATION TO: MISSOURI DEPARTMENT OF NATURAL RESOURCES,
MISSOURI GEOLOGICAL SURVEY, GEOLOGIC RESOURCES SECTION, PO BOX 250, ROLLA, MO 65402
PHONE: 573-368-2100 FAX: 573-368-2111 EMAIL:
oilandgas@dnr.mo.gov
INJECTION PERMIT TRANSFER INFORMATION (Attach a list in this format if necessary)
REQUESTED DATE OF INJECTION PERMIT TRANSFER
*INJECTION TYPE CODE
SWD (SALTWATER DISPOSAL WELL), EOR (ENHANCED OIL RECOVERY), (O) (OTHER, EXPLANATION NECESSARY)
API Number
Well Number
Injection Type*
Approved Maximum Pressure Approved Maximum Rate
Approved Monthly Volume
WELL AND INJECTION PERMIT PRE TRANSFER REQUIREMENTS
A lease boundary map showing well locations of all open wells (transferred and non-transferred) must be submitted with this request.
All non-transferred open wells in this lease area must be plugged in accordance with 10 CSR 50-2.060 before transfer of well(s) and injection
permits will be approved.
If the transferee purchases the property, they assume responsibility for all unknown abandoned wells in this lease area.
The transferee must have a current Missouri Oil and Gas operator’s license and sufficient bonding in place for the transferred well(s) and the
associated injection permit(s).
The approval of a well transfer or an injection permit may be dependent upon the resolution of outstanding enforcement issues.
The transferor may be required to conduct a mechanical integrity test as a condition of the transfer.
WELL AND INJECTION PERMIT POST TRANSFER REQUIREMENTS
Within 90 days of approved transfer of well(s) and the associated injection permit(s), the transferee shall:
Change the tank battery identification sign provided for in 10 CSR 50-2.010(6)(A)(7) to include new operator information.
Install well signage, if necessary, in accordance with 10 CSR 50-2.040(13).
CERTIFICATION
We, the undersigned, certify that:
We are authorized by said companies to make this transfer.
The facts stated herein are true, correct and complete to the best of our knowledge.
We understand this form shall be submitted no less than thirty (30) days prior to the planned transfer of the well(s) and injection permit(s).
We have read, understand and are in compliance with the well and injection permit transfer requirements listed on this form.
TRANSFEROR SIGNATURE
TRANSFEROR NAME (PRINT)
TITLE
DATE
TRANSFEREE SIGNATURE
TRANSFEREE NAME (PRINT)
TITLE
DATE
FOR OFFICE USE ONLY
EARLIEST DATE FOR APPROVED TRANSFER
APPROVED BY
DATE
MO 780-2634 (04-18)
SEND COMPLETED FORM ALONG WITH REQUESTED INFORMATION TO: MISSOURI DEPARTMENT OF NATURAL RESOURCES,
MISSOURI GEOLOGICAL SURVEY, GEOLOGIC RESOURCES SECTION, PO BOX 250, ROLLA, MO 65402
PHONE: 573-368-2100 FAX: 573-368-2111 EMAIL:
oilandgas@dnr.mo.gov
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