Form 29 - Local Governmental Designee

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FORM
FOR OGCC USE ONLY
29
State of Colorado
Rev 4/11
Oil and Gas Conservation Commission
1120 Lincoln Street, Suite 801, Denver, Colorado 80203 (303)894-2100 Fax:(303)894-2109
LOCAL GOVERNMENTAL DESIGNEE
The Local Governmental Designee status entitles local government entities to notification of oil and gas operations under the rules and regulations of the
Colorado Oil and Gas Conservation Commission (COGCC). In order for those regulations to be in effect the local government entity must furnish the
COGCC one particular individual who will act as the Designee. This Designee will be responsible to distribute notifications to affected departments within
the local government. Information provided to the COGCC is available to anyone on the Internet at by clicking on the Local Gov
button and searching by any identified local government entity. Local governments that do not wish to participate in the Local Government Designee
program are encouraged to supply the contact information requested below in order to provide citizens and oil and gas operators with accurate
information should a need arise. Submit/Fax to 303 894 2109 Attn: Hearings Assistant.
The
County;
Municipality;
Special District of: _____________________________
(Check all that apply)
will not participate with a Local Governmental Designee.
will participate with a Local Governmental Designee.
Name:
_____________________________________________________
Title:
_____________________________________________________
Organization:
_____________________________________________________
Address:
_____________________________________________________
City, State, Zip:
_____________________________________________________
Telephone:
_____________________________________________________
Fax:
_____________________________________________________
E-Mail:
_____________________________________________________
Emergency Contact Name:
_____________________________________________________
Emergency Dispatch No.:
_____________________________________________________
Emergency Number:
_____________________________________________________
DESIGNEE REQUEST FOR ONSITE CONSULTATION:
Desires onsite consultation prior to commencement of operations per Rule 306.b.(1).
DESIGNEE REQUEST FOR FORMS/NOTICES:
(Permits are available on the COGCC web site as soon as they are processed or created.
To view approved and pending permits select “Permits” from the menu on our home page.)
General E-Mail Notification – Receive links to the Staff Report, Hearing Notices
and Hearing Applications (Approximately every five to six weeks).
Desires eForm credentials and notices (Allows comments on Application for
Oil and Gas Location Assessments and Permits to Drill (APDs) in your jurisdiction).
Signature: _________________________________________
Date: _________________

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