Form 31 - Underground Injection Formation Permit Application
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FORM
31
State of Colorado
FOR OGCC USE ONLY
Rev 6/99
Oil and Gas Conservation Commission
1120 Lincoln Street, Suite 801, Denver, Colorado 80203 (303)894-2100 Fax:(303)894-2109
UNDERGROUND INJECTION FORMATION PERMIT APPLICATION
. Submit original and one copy of this form.
1
Complete the
2. If data on this form is estimated, indicate as such.
Attachment Checklist
3. Attachments – see checklist and explanation of attachments.
Oper OGCC
4. Aquifer exemption is required for all injection formations with water quality <10,000 TDS (Rule 322B).
F Copy
Form 31 Original & 1 Copy
Immediately contact the Commission for further requirements if the total dissolved solids (TDS) as determined by
water analysis for the injection zone is less than 10,000 ppm.
Analysis fo Injection Zone Water
Analysis of Injection Zone Water
Analysis of Injection Water
5. Attach a copy of the certified receipt to each notice to surface and mineral owner(s) or submit a sample copy of
Analysis of Injection Water
the notice and an affidavit of mailing or delivery with names and addresses of those notified. Each person notified
Proposed Injection Program
Proposed Injection Program
shall be specified as either a surface or mineral owner as defined by C.R.S. 34-60-103(7).
Resistivity or Induction Log
Copy of Resistivity or Induction Log
Cement Bond Log
Copy of Cement Bond Log
Surface or Salt Water Displ Agrmt
Surface or SaltWater Disposal Agrmnt
Notice to Surface/Mineral Owners
Project Name: _______________________________ Project Location: _________________________________
Notice to Surface & Mineral Owners
Remedial Correction Plan for Wells
Project Type:
Enhanced Recovery
Disposal
Simultaneous Disposal
Remedial Correction Plan for Wells
Map Oil/Water Wells w/in 1/4 Mile
Map of Oil/Water Wells w/in1/4 Mile
Single or Multiple Well Facility?
Single
Multiple
List Oil/Gas Wells w/in 1/2 Mile
List of Oil/Gas Wells w/in 1/2 Mile
IF UNIT OPERATIONS, ATTACH PLAT SHOWING UNIT AREA
Map Surface Owners w/in 1/4 Mile
Map of Surface Owners w/in 1/4 Mile
County: ________________________________ Field Name and Number: ______________________________
List Surface Owners w/in 1/4 Mile
List of Surface Owners w/in 1/4 Mile
Map Mineral Owners w/in 1/4 Mile
Map of Mineral Owners w/in 1/4 Mile
OGCC Operator Number:__________________________
Contact Name and Telephone:
List Mineral Owners w/in 1/4 Mile
List of Mineral Owners w/in 1/4 Mile
Surface Facility Diagram
_______________________________________
Name of Operator:_________________________________________
Surface Facility Diagram
Wellbore Diagram
No:____________________________
Address:_________________________________________________
If Commercial Facility, Description of
If Commercial Facility, Description
Fax:____________________________
Operations and Area Served
of Ops & Area Served
City:___________________________ State:_____ Zip:___________
Unit Area Plat
Unit Area Plat
Injection Fluid Type:
Produced Water
Natural Gas
CO
Drilling Fluids
2
Exempt Gas Plant Waste
Used Workover Fluids
Other Fluids (describe):______________________________
Commercial Facility?
Yes
No
If Yes, describe area of operation and types of fluids to be injected at this facility:
PROPOSED INJECTION FORMATIONS
FORMATION A (Name): ___________________________________________________
Porosity: __________________________
Formation TDS: _______________________ Frac Gradient: ____________________________psi/ft Permeability:_____________________
Proposed Stimulation Program:
Acid
Frac Treatment
None
FORMATION B (Name): ___________________________________________________
Porosity: __________________________
Formation TDS: _______________________ Frac Gradient: ____________________________psi/ft Permeability:_____________________
Proposed Stimulation Program:
Acid
Frac Treatment
None
Anticipated Project Operating Conditions
Under normal operating conditions, estimated fluid injection rates and pressures:
FOR WATER: A minimum of _______ bbls/day @ ______ psi
to
a maximum of _______ bbls/day @ _______ psi.
FOR GAS:
A minimum of _______ mcf/day @ ______ psi
to
a maximum of _______ bbls/day @ _______ psi.
I hereby certify that the statements made in this form are, to the best of my knowledge, true, correct, and complete.
Print Name: _________________________________________ Signed: ________________________________________
Title:__________________________________________ Date:_____________________
OGCC Approved: ________________________________ Title:________________________________ Date:_____________
UIC FACILITY NO:
Order No:__________________________________
:
CONDITIONS OF APPROVAL, IF ANY
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