Form C-137A "Application for Minor Modification to Surface Waste Management Facility" - New Mexico

What Is Form C-137A?

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

Form Details:

  • Released on June 30, 2016;
  • The latest edition provided by the New Mexico Energy, Minerals and Natural Resources Department;
  • 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 C-137A by clicking the link below or browse more documents and templates provided by the New Mexico Energy, Minerals and Natural Resources Department.

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Download Form C-137A "Application for Minor Modification to Surface Waste Management Facility" - New Mexico

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For State Use Only:
District I
State of New Mexico
1625 N. French Dr., Hobbs, NM 88240
Energy Minerals and Natural Resources
District II
811 S. First St., Artesia, NM 88210
Form C-137A
District III
Oil Conservation Division
June 30, 2016
1000 Rio Brazos Road, Aztec, NM 87410
1220 South St. Francis Dr.
District IV
Submit 1 Copy to Santa Fe Office
1220 S. St. Francis Dr., Santa Fe, NM 87505
Santa Fe, NM 87505
APPLICATION FOR MINOR MODIFICATION TO SURFACE WASTE
MANAGEMENT FACILITY
1. Operator: _______________________________________________________________________________________
Address: _______________________________________________________________________________________
Contact Person: ____________________________________________Phone: _______________________________
2. Location: __________/4 __________/4 Section ______________Township _____________Range ___________
3. Provide permit number _______________
4. Attach a description of the proposed minor modification(s) to the surface waste management facility.
5. If the Minor Modification involves changes to a treatment, remediation, or disposal method, attach engineering designs,
certified by a registered professional engineer, including technical data on the design elements of each applicable treatment,
remediation, and disposal method and detailed designs of surface impoundments.
6. If the Minor Modification will affect the closure and post-closure plan, attach an updated closure and post closure plan,
including a responsible third party contractor’s cost estimate, sufficient to close the surface waste management facility in a
manner that will protect fresh water, public health, and the environment (the closure and post closure plan shall comply with the
requirements contained in 19.15.36.18 NMAC).
7. If the Minor Modification will affect the contingency plan, attach an updated contingency plan that complies with the
requirements of Subsection N of 19.15.36.13 NMAC and with NMSA 1978, Sections 12-12-1 through 12-12-30, as amended
(the Emergency Management Act).
8. If the Minor Modification will affect the control of run-on or run-off water at the site, attach an updated plan to control run-
on water onto the site and run-off water from the site that complies with the requirements of Subsection M of 19.15.36.13
NMAC.
9. If the Minor Modification will affect the best management practice plan, attach a best management practice plan to ensure
protection of fresh water, public health, and the environment.
10. The division may require additional information to demonstrate that the surface waste management facility’s operation will
not adversely impact fresh water, public health, or the environment and that the surface waste management facility will comply
with division rules and orders.
11. CERTIFICATION
I hereby certify that the information submitted with this application is true, accurate, and complete to the best of my knowledge
and belief.
Name: ______________________________________________
Title: ___________________________________
Date: ___________________________________
Signature: ___________________________________________
E-mail Address: _____________________________________
For State Use Only:
District I
State of New Mexico
1625 N. French Dr., Hobbs, NM 88240
Energy Minerals and Natural Resources
District II
811 S. First St., Artesia, NM 88210
Form C-137A
District III
Oil Conservation Division
June 30, 2016
1000 Rio Brazos Road, Aztec, NM 87410
1220 South St. Francis Dr.
District IV
Submit 1 Copy to Santa Fe Office
1220 S. St. Francis Dr., Santa Fe, NM 87505
Santa Fe, NM 87505
APPLICATION FOR MINOR MODIFICATION TO SURFACE WASTE
MANAGEMENT FACILITY
1. Operator: _______________________________________________________________________________________
Address: _______________________________________________________________________________________
Contact Person: ____________________________________________Phone: _______________________________
2. Location: __________/4 __________/4 Section ______________Township _____________Range ___________
3. Provide permit number _______________
4. Attach a description of the proposed minor modification(s) to the surface waste management facility.
5. If the Minor Modification involves changes to a treatment, remediation, or disposal method, attach engineering designs,
certified by a registered professional engineer, including technical data on the design elements of each applicable treatment,
remediation, and disposal method and detailed designs of surface impoundments.
6. If the Minor Modification will affect the closure and post-closure plan, attach an updated closure and post closure plan,
including a responsible third party contractor’s cost estimate, sufficient to close the surface waste management facility in a
manner that will protect fresh water, public health, and the environment (the closure and post closure plan shall comply with the
requirements contained in 19.15.36.18 NMAC).
7. If the Minor Modification will affect the contingency plan, attach an updated contingency plan that complies with the
requirements of Subsection N of 19.15.36.13 NMAC and with NMSA 1978, Sections 12-12-1 through 12-12-30, as amended
(the Emergency Management Act).
8. If the Minor Modification will affect the control of run-on or run-off water at the site, attach an updated plan to control run-
on water onto the site and run-off water from the site that complies with the requirements of Subsection M of 19.15.36.13
NMAC.
9. If the Minor Modification will affect the best management practice plan, attach a best management practice plan to ensure
protection of fresh water, public health, and the environment.
10. The division may require additional information to demonstrate that the surface waste management facility’s operation will
not adversely impact fresh water, public health, or the environment and that the surface waste management facility will comply
with division rules and orders.
11. CERTIFICATION
I hereby certify that the information submitted with this application is true, accurate, and complete to the best of my knowledge
and belief.
Name: ______________________________________________
Title: ___________________________________
Date: ___________________________________
Signature: ___________________________________________
E-mail Address: _____________________________________