Bonding-Insurance Forms

Coal Bearing Township Information

• Designated Coal Bearing Areas (pdf)

Idle-Orphan Well Forms

• Landowner Grant Application
• Landowner Grant Plugging Specifications
• Plugging Application & Right-of-Entry Release

Permitting Forms

• Application for Permit (Form 1)
• Application for Permit Supplement (Form 1A)  
• Documents Required for a Domestic Owner
• Documents Required for a Non-domestic Owner
• Documents Required to File for a Permit
• Landowner Waiver (Form 5)
• Oil-Gas Affidavit
• Requirements for Filing a Mandatory Pooling Application
• Restoration Plan (Form 4)
• Well Completion Record (Form 8)
• Well Plugging Report (Form 55)

Production Forms

• Annual Statement of Production (Form 10)

UIC Forms

• Aggregate Brine Application Annual Report
• Annular Disposal Application
• Annular Disposal Well Reporting Sheet (Form 205)
• Brine Hauler Annual Report (Form 13)
• Brine Hauler Bond (Form 18)
• Brine Transporter Registration (Form 12)
• ERP Additional Wells (Form 204B)
• ERP Affidavit
• ERP Annual Report (Form 204)
• ERP Supplement (Form 203)
• Saltwater Injection Well Affidavit
• Saltwater Injection Well Supplement (Form 210)
• Solution Mining Project Supplement (Form 206)
• Solution Mining Quarterly Report (Form 207)
• Surface Application Annual Report (Form 15)
• Surface Casing Affidavit
• Ground Water Contamination - Presence of Gas
• Ground Water Contamination - Disruption Questionnaire
• Ground Water Contamination - Presence of Oil
• Ground Water Contamination - Presence of Salty Water
• Ground Water Disruption - Decreased Supply and Siltation

Water Sampling

• Water Sampling form (pdf)
• Water Sampling form (xls)