Form Ogb - 1d - Application For Permit To Inject Storage Gas

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STATE OIL AND GAS BOARD OF ALABAMA
Form OGB - 1D
420 Hackberry Lane
5 / 00
P.O. Box 869999
Permit number
Tuscaloosa, Alabama 35486-6999
01-
-
Fax (205)349-2861
(205) 349-2852
API number
Application for Permit to Inject Storage Gas
Solution-mined cavity
Reservoir Storage
(file in triplicate)
Name of operator
Date
State
Zip
Address
City
Well name and number
County
(give footage from nearest section or tract lines)
Section-Township-Range or Tract
Well
Location
.
Latitude
.
Longitude
Elevation
Facility
(ground)
Nearest solution-mined cavity
Distance (ft)
Total Depth (ft)
Permit no.
(if applicable)
Date of OGB conceptual approval
Approx. date injection to begin
(Step 1)
Proposed injection
Source(s) of
Estimated daily injection volume
fluid(s)
fluids
Min.
Max.
Anticipated injection pressure (psi)
Proposed injection formation
Formation fracture
Depth
Avg.
Name
pressure (psi)
Max.
Base of fresh water (<10,000 mg/L TDS)
Base of significant aquiclude
Formation
Depth
Formation
Depth
Initial pressure test date
If witnessed by agent of board, give name
Person to contact
Phone number
regarding permit
Fax number
application
E-Mail address
Remarks:
, 20
Executed this the
day of
Signature
Before me, the undersigned authority, on this day personally appeared
known to me to be the person
whose name is subscribed to the above instrument, who being by me duly sworn on oath states that he/she is duly authorized to make the above report and that he/she
has knowledge of the facts stated therein, and that said report is true and correct.
day of
, 20
Subscribed and sworn to before me this
SEAL
Notary Public in and for
County,
My commission expires
ACTION OF STATE OIL AND GAS BOARD
Approved
Conditionally Approved
SUBJECT TO:
1. All rules and regulations of the State Oil and Gas Board
2. Additional conditions:
APPROVED BY
DATE

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