Get Underground Injection Control (uic) Well Registration Form For ... - Fortress Wa

Completing the Underground Injection Control (UIC) Well Registration Form is an essential step for registering wells that meet nonendangerment standards. This guide offers clear, step-by-step instructions to help you fill out the form accurately and effectively.

Follow the steps to complete the UIC Well Registration Form online.

1. Click the ‘Get Form’ button to access the UIC Well Registration Form and open it in your preferred online editor.
2. In section A, provide the facility name, address, city, state, ZIP code, phone number, county, and the specific township, range, section, and quarter-quarter where the facility is located.
3. In section B, fill out the well owner’s information, including their name, organization, address, city, state, ZIP code, phone number, and email. If the property owner is different, input their details as well.
4. Include information about the technical contact person, such as their name, organization, address, city, state, ZIP code, phone number, and email.
5. Move to section C and select the type of Class V Well you are registering. Use the provided list to fill in the corresponding number in the well table.
6. In the UIC well information section, create an owner's ID name or number for your well. Complete the fields for the well type number, construction date, EPA well type, and status (Active, Unused, Closed, or Proposed).
7. Document the depth of the UIC well and enter the latitude and longitude in decimal degrees. You can find this information using a mapping tool provided by the Washington Department of Health.
8. If applicable, fill out the permit information related to your UIC well, including permit type, ID number, and issuing agency.
9. In the signature section, the legally authorized representative should sign and date the document to certify the information's accuracy.
10. Finally, review all entries for completeness and accuracy, then save the document. You can choose to download, print, or share your completed form as needed.

For further assistance or to complete your document online, please proceed with the UIC Well Registration Form.