Forms
| Underground Injection Control (UIC) Permits | |||
|---|---|---|---|
| Form Description | Revision | Format | |
| -- | -- | ||
| 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 | -- |  | 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 | -- | | Online |
UIC Sample List 2 | -- | | Online |
UIC Sample List 3 | -- | | 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 |
Injection Well Notification Form | -- | | Online |
Class V Well Pre-closure Notification Form | 05/17 |
| Online |
Requests for Tracer Use in Ground Water | -- | | Online |
UIC Permit Cancellation Guidance | -- | | -- |