Loading
Form preview picture

Get Disposal Report Form

SALTWATER DISPOSAL REPORT - FORM 16 Page of INDUSTRIAL COMMISSION OF NORTH DAKOTA OIL AND GAS DIVISION 600 EAST BOULEVARD DEPT 405 BISMARCK ND 58505-0840 Amended SFN 5763 01-2001 PLEASE READ INSTRUCTIONS BEFORE FILLING OUT FORM. 9. Monthly barrels transported shall be totaled at the end of the report. 10. If more space is needed to complete the source of disposal water and method of transportation portion of this report attach a Saltwater Disposal Report Continuation Form 16A SFN 5764. This report is required as a regular monthly report regardless of the status of operations. 2. This completed report shall be a sworn report as provided for in Section 43-02-05-12 of the North Dakota Administrative Code NDAC. 3. Please refer to Section 43-02-05-12 NDAC regarding reporting requirements for injection wells. 4. The well name and number field UIC number and location of the saltwater disposal well and the operators well names and numbers well file numbers and locations of the source wells shall coincide with the official records on file with the Commission. 5. PLEASE SUBMIT THE ORIGINAL. Well Name and Number Reset View Field Print Well File Number UIC Number Telephone Number Operator Address Location of Well For Month/Year City Qtr-Qtr Township Section County Range N Is Oil Skimmed From Water Yes No Zip Code State W If Yes Oil Recovered From Saltwater Disposal Wells Report - Form 5 SWD SFN 5752 and Authorization to Purchase and Transport Oil from Lease - Form 8 SFN 5698 must be filed with the Commission. Beginning of Month Meter Reading End of Month Meter Reading Monthly Barrels Injected Average Daily Injection Pressure PSI SOURCE OF DISPOSAL WATER AND METHOD OF TRANSPORTATION Well File Number Operator Well Name and Number Location Qtr-Qtr S-T-R Pit P or Well W Transported Monthly Total Comments I hereby swear or affirm that the information provided is true complete and correct as determined from all available records. Signature Printed Name Title Above Signature Witnessed By Witness Signature Witness Printed Name Witness Title Date Pipeline P or Truck T SFN 5763 1. This report is required as a regular monthly report regardless of the status of operations. 2. This completed report shall be a sworn report as provided for in Section 43-02-05-12 of the North Dakota Administrative Code NDAC. 3. Please refer to Section 43-02-05-12 NDAC regarding reporting requirements for injection wells. 4. The well name and number field UIC number and location of the saltwater disposal well and the operators well names and numbers well file numbers and locations of the source wells shall coincide with the official records on file with the Commission* 5. All volumes shall be reported as barrels 42 gallons and rounded to the nearest full barrel* 6. The operators of source wells that dispose of fluids in this disposal well shall be listed* 7. If the source of disposal water is not a particular well site only the location need be listed* 8. When reporting source of disposal water and method of transportation a P or W is sufficient to indicate pit or well water and a P or T is sufficient to indicate transportation by pipeline or truck.

How It Works

disposal report sample rating
4.8Satisfied
35 votes

Tips on how to fill out, edit and sign Township online

How to fill out and sign Coincide online?

Get your online template and fill it in using progressive features. Enjoy smart fillable fields and interactivity. Follow the simple instructions below:

Finding a legal professional, creating an appointment and coming to the office for a personal conference makes doing a Disposal Report Form from beginning to end tiring. US Legal Forms allows you to rapidly generate legally binding documents based on pre-built online samples.

Perform your docs within a few minutes using our easy step-by-step guide:

  1. Get the Disposal Report Form you require.
  2. Open it up with cloud-based editor and begin altering.
  3. Fill in the empty fields; concerned parties names, addresses and phone numbers etc.
  4. Customize the template with exclusive fillable fields.
  5. Add the particular date and place your e-signature.
  6. Simply click Done after twice-checking all the data.
  7. Download the ready-created document to your gadget or print it like a hard copy.

Quickly produce a Disposal Report Form without having to involve specialists. We already have more than 3 million people taking advantage of our unique catalogue of legal forms. Join us today and get access to the top catalogue of browser-based samples. Give it a try yourself!

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Psi FAQ

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.

Keywords relevant to Disposal Report Form

  • SWD
  • S-T-R
  • affirm
  • amended
  • skimmed
  • Continuation
  • psi
  • DEPT
  • township
  • Saltwater
  • succeeding
  • coincide
  • volumes
  • totaled
  • Operators
If you believe that this page should be taken down, please follow our DMCA take down processhere.
Ensure the security of your data and transactions

USLegal fulfills industry-leading security and compliance standards.

  • 
                            VeriSign logo picture

    VeriSign secured

    #1 Internet-trusted security seal. Ensures that a website is free of malware attacks.

  • Accredited Business

    Guarantees that a business meets BBB accreditation standards in the US and Canada.

  • 
                            TopTenReviews logo picture

    TopTen Reviews

    Highest customer reviews on one of the most highly-trusted product review platforms.