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
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
