DEQ Form 652-600 "Injection Well Monthly Report" - Oklahoma

What Is DEQ Form 652-600?

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

Form Details:

  • Released on July 1, 2016;
  • The latest edition provided by the Oklahoma Department of Environmental Quality;
  • 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 DEQ Form 652-600 by clicking the link below or browse more documents and templates provided by the Oklahoma Department of Environmental Quality.

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Download DEQ Form 652-600 "Injection Well Monthly Report" - Oklahoma

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EPA ID No.________________________________
Permit No._________________________________
Date______________________________________
______________________________________________________________________________
INJECTION WELL MONTHLY REPORT
Company Name, Address, Telephone
Facility Name and Address (if different)
This report is to be completed on a monthly basis by all non-hazardous Class I injection wells as defined by 40 CFR
144.6 (a)(2). This report is to be received by the Oklahoma Department of Environmental Quality, Land Protection
Division, no later than 15 days after the end of the calendar quarter.
I hereby certify that this record is correct and accurate to the best of my knowledge, and lists all wastes received by
this site for the month of ___________________________________, 20______.
______________________________________________________________________________
Signature of Site Owner/Operator
Date
Revised July 2016
DEQ Form # 652-600
EPA ID No.________________________________
Permit No._________________________________
Date______________________________________
______________________________________________________________________________
INJECTION WELL MONTHLY REPORT
Company Name, Address, Telephone
Facility Name and Address (if different)
This report is to be completed on a monthly basis by all non-hazardous Class I injection wells as defined by 40 CFR
144.6 (a)(2). This report is to be received by the Oklahoma Department of Environmental Quality, Land Protection
Division, no later than 15 days after the end of the calendar quarter.
I hereby certify that this record is correct and accurate to the best of my knowledge, and lists all wastes received by
this site for the month of ___________________________________, 20______.
______________________________________________________________________________
Signature of Site Owner/Operator
Date
Revised July 2016
DEQ Form # 652-600
Facility Name: ______________________________________
EPA ID No.:________________________________________
Permit No.:_________________________________________
Date: ______________________________________________
INJECTION WELL MONTHLY REPORT
Well No.
Well No.
Month/Number of days any injection occurred
/
/
Part I
VOLUME (gallons)
Volume for month
Cumulative Total (for the year)
Average Daily (when injecting)
Maximum Daily
Minimum Daily (when injecting)
SURFACE INJECTION PRESSURE (psi)
Average (when injecting)
Maximum
ANNULAR PRESSURE (psi)
Average (when pressurized)
Maximum
Minimum (at any time)
INJECTION RATE (gpm)
Average (when injecting)
Maximum
Part II
AS AN ATTACHMENT, ENCLOSE THE FOLLOWING INFORMATION FOR EACH WELL
1.
Describe all fluids injected during the month showing:
A. Origin of each injection stream;
Percent concentration of the major constituents of each injection stream, if applicable;
B.
Physical description of each injection stream—such as color, turbidity, odor, density, viscosity, temperature;
C.
D. Groundwater analysis of the deep monitor well.
2.
Describe and give the results of any pertinent activities conducted during the month including, but not limited to:
A. Well workover operations;
Mechanical integrity tests performed (whether by operator or DEQ official);
B.
Calibration and other maintenance of monitoring equipment.
C.
3.
Explain any unusual occurrences in the monitoring record during the month, including, but not limited to:
A. Breaks or inconsistencies;
Injection pressure exceeding permitted maximum;
B.
Annular pressure drop below permitted minimum;
C.
D. Maintenance to annular fluid volume or pressure.
I hereby certify that the information submitted in this and all attached documents is accurate and complete.
_________________________________________________________
________________________________
(Signature of authorized representative)
(Date)
_____________________________________________________________
________________________________
(Name and title)
(Telephone)
File this report no later than 15 days after the end of the calendar quarter to:
Department of Environmental Quality
Land Protection Division
P.O. Box 1677
Oklahoma City, Oklahoma 73101-1677
Revised July 2016
DEQ Form # 652-600
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