Forms

Underground Injection Control (UIC) Permits
Form DescriptionRevisionFormat
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Note: Submission of a complete UIC application consists of a completed Form U200 and completion of the attachments from one of the other forms: U201, U202 or U203. Use the attachment form that applies to your type of UIC well.   

UIC Form U100: Quarterly Class II Disposal/Injection Well Monitoring Report Form

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Online

UIC Form U110: UIC Mechanical Integrity Test Report Form

05/17

Online

UIC Form U111: UIC Mechanical Integrity Test Report - Geothermal

05/17

Online

UIC Form U120: UIC Injection Well Completion Report (Class II/Geothermal)

05/17

Online

UIC Form U200: UIC Permit Application

05/17

Online

UIC Form U201: General Class 5 Well Attachments

05/17

Online

UIC Form U202: Class 2 Oil/Gas, Class 3 Solution Mining, or Class 5 Geothermal Well Attachments

05/17

Online

UIC Form U203: Class 5 Remediation or Tracer Test Attachments

05/17

Online

UIC Form U210: UIC Remediation NOI

11/17

Online

UIC Form U211: Approval Request for Domestic Geothermal Injection Wells

05/17

Online

UIC Form U220: UIC Permit Acknowledgement Form U220

05/17

Online

UIC Form U230: UIC Field Sampling & Monitoring Summary

05/17

Online

UIC Sample List 1

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Online

UIC Sample List 2

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Online

UIC Sample List 3

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Online

UIC Water Sample List – Class 2 wells

05/17

Online

UIC Form U240: UIC Requests for Chemical Use

05/17

Online

UIC Form U250: Notice to Transfer Injection Permit / Change of Ownership

05/17

Online

UIC Form U310: UIC Notice of Termination

10/16

Online

Discharge Basin Form - Associated with UIC Permit

05/17

Online

Oil/Water Separator Notice of Intent (NOI)

05/17

Online

Injection Well Notification Form

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Online

Class V Well Pre-closure Notification Form

05/17

Online

Requests for Tracer Use in Ground Water

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Online

UIC Permit Cancellation Guidance

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