Form C-147 "Permit or Registration for Recycling and Re-use of Produced Water, Drilling Fluids and Liquid Oil Field Waste" - New Mexico

What Is Form C-147?

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 April 3, 2017;
  • 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-147 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-147 "Permit or Registration for Recycling and Re-use of Produced Water, Drilling Fluids and Liquid Oil Field Waste" - New Mexico

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State of New Mexico
Form C-147
District I
Revised April 3, 2017
1625 N. French Dr., Hobbs, NM 88240
Energy Minerals and Natural Resources
District II
Department
.
811 S. First St., Artesia, NM 88210
District III
Oil Conservation Division
1000 Rio Brazos Road, Aztec, NM 87410
1220 South St. Francis Dr.
District IV
1220 S. St. Francis Dr., Santa Fe, NM 87505
Santa Fe, NM 87505
Recycling Facility Only
Type of action:
Permit
Registration
Modification
Closure
Other (explain) ___________________
Be advised that approval of this request does not relieve the operator of liability should operations result in pollution of surface water, ground water or the environment.
Nor does approval relieve the operator of its responsibility to comply with any other applicable governmental authority's rules, regulations or ordinances.
1.
Operator: ______________________________________________(For multiple operators attach page with information) OGRID #:_______________
Address: ____________________________________________________________________________________________________________________
Facility or well name (include API# if associated with a well): __________________________________________________________________________
OCD Permit Number: ___________________________(For new facilities the permit number will be assigned by the district office)
U/L or Qtr/Qtr ______________ Section ____________ Township ____________ Range ____________ County: ________________________________
Surface Owner:
Federal
State
Private
Tribal Trust or Indian Allotment
2.
Recycling Facility:
Location of recycling facility (if applicable): Latitude __________________________ Longitude __________________________ NAD83
Proposed Use:
Drilling*
Completion*
Production*
Plugging *
*The re-use of produced water may NOT be used until fresh water zones are cased and cemented
Other, requires permit for other uses. Describe use, process, testing, volume of produced water and ensure there will be no adverse impact on
groundwater or surface water.
Fluid Storage
Above ground tanks
Activity permitted under 19.15.17 NMAC explain type___________________________
Activity permitted under 19.15.36 NMAC explain type:___________________________
Other explain __________________________
Closure Report (required within 60 days of closure completion):
Recycling Facility Closure Completion Date:_______________________
3.
Variances:
Justifications and/or demonstrations that the proposed variance will afford reasonable protection against contamination of fresh water, human health, and the
environment.
Check the below box only if a variance is requested:
Variance(s): Requests must be submitted to the appropriate division district for consideration of approval. If a Variance is requested, include the
variance information on a separate page and attach it to the C-147 as part of the application.
If a Variance is requested, it must be approved prior to implementation.
4.
Operator Application Certification:
I hereby certify that the information and attachments submitted with this application are true, accurate and complete to the best of my knowledge and belief.
Name (Print): _________________________________________________________
Title: ______________________________________________
Signature:_______________________________________________________________
Date: ____________________________________________
e-mail address:________________________________________________________
Telephone: ___________________________________________
5.
OCD Representative Signature: _________________________________________________ Approval/Registration Date:____________________
Title: _______________________________________________________
OCD Permit Number:_______________________________________
OCD Conditions _______________________________________________
Additional OCD Conditions on Attachment
Oil Conservation Division
Page 1 of 1
State of New Mexico
Form C-147
District I
Revised April 3, 2017
1625 N. French Dr., Hobbs, NM 88240
Energy Minerals and Natural Resources
District II
Department
.
811 S. First St., Artesia, NM 88210
District III
Oil Conservation Division
1000 Rio Brazos Road, Aztec, NM 87410
1220 South St. Francis Dr.
District IV
1220 S. St. Francis Dr., Santa Fe, NM 87505
Santa Fe, NM 87505
Recycling Facility Only
Type of action:
Permit
Registration
Modification
Closure
Other (explain) ___________________
Be advised that approval of this request does not relieve the operator of liability should operations result in pollution of surface water, ground water or the environment.
Nor does approval relieve the operator of its responsibility to comply with any other applicable governmental authority's rules, regulations or ordinances.
1.
Operator: ______________________________________________(For multiple operators attach page with information) OGRID #:_______________
Address: ____________________________________________________________________________________________________________________
Facility or well name (include API# if associated with a well): __________________________________________________________________________
OCD Permit Number: ___________________________(For new facilities the permit number will be assigned by the district office)
U/L or Qtr/Qtr ______________ Section ____________ Township ____________ Range ____________ County: ________________________________
Surface Owner:
Federal
State
Private
Tribal Trust or Indian Allotment
2.
Recycling Facility:
Location of recycling facility (if applicable): Latitude __________________________ Longitude __________________________ NAD83
Proposed Use:
Drilling*
Completion*
Production*
Plugging *
*The re-use of produced water may NOT be used until fresh water zones are cased and cemented
Other, requires permit for other uses. Describe use, process, testing, volume of produced water and ensure there will be no adverse impact on
groundwater or surface water.
Fluid Storage
Above ground tanks
Activity permitted under 19.15.17 NMAC explain type___________________________
Activity permitted under 19.15.36 NMAC explain type:___________________________
Other explain __________________________
Closure Report (required within 60 days of closure completion):
Recycling Facility Closure Completion Date:_______________________
3.
Variances:
Justifications and/or demonstrations that the proposed variance will afford reasonable protection against contamination of fresh water, human health, and the
environment.
Check the below box only if a variance is requested:
Variance(s): Requests must be submitted to the appropriate division district for consideration of approval. If a Variance is requested, include the
variance information on a separate page and attach it to the C-147 as part of the application.
If a Variance is requested, it must be approved prior to implementation.
4.
Operator Application Certification:
I hereby certify that the information and attachments submitted with this application are true, accurate and complete to the best of my knowledge and belief.
Name (Print): _________________________________________________________
Title: ______________________________________________
Signature:_______________________________________________________________
Date: ____________________________________________
e-mail address:________________________________________________________
Telephone: ___________________________________________
5.
OCD Representative Signature: _________________________________________________ Approval/Registration Date:____________________
Title: _______________________________________________________
OCD Permit Number:_______________________________________
OCD Conditions _______________________________________________
Additional OCD Conditions on Attachment
Oil Conservation Division
Page 1 of 1