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Oil and Gas Program Forms

Completed forms must be submitted electronically and by hard copy to:

DEMLRoilandgas@ncdenr.gov

DEMLR/Oil and Gas Program
1612 Mail Service Center
Raleigh, NC 27699-1612

Questions? Contact the Oil and Gas Program Staff.

Forms
Form 1 – Financial Responsibility Ownership
Form 2 – Oil or Gas Well Permit Application
Form 3 – Well Construction Design
Form 4 – Water Management Plan
Form 5 – Waste Management Plan
Form 6 – Well Site Reclamation Plan 
Form 7 – Irrevocable Letter of Standby Credit
Form 8 – Surety Bond
Form 9 – Assignment of Savings
Form 10 – Cash Deposit
Form 11 – Required Notifications to the Department
Form 12 – Well Drilling Report 
Form 13 – Reserved for future use.
Form 14 – Plugging and Abandonment 
Form 15 – Oil or Gas Well Status 
Form 16 – Mechanical Integrity Test Results   
Form 17 – Notification of Return of Oil or Gas Well to Active Status
Form 18 – Well Stimulation Report
Form 18A – Well Stimulation Report - Addendum
Form 19 – Chemical Disclosure Report
Form 20 – Confidential Information Claim
Form 21 – Water Supply Investigation Request
Form 22 – Water Supply Testing Report 
Form 22A – Water Supply Testing- Data Tables
Form 23 – Annual Water Use Report 
Form 24 – Annual E & P Waste Management Report
Form 25 – Pit Closure Report
Form 26 – Spill and Release Report
Form 27 – Site Investigation and Remediation Work Plan
Form 28 – Monthly Production Report
Form 29 – Well Site Inspection Report
Supplemental Form - Comments/Reporting

 

 

 
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