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http://www.epa.gov/reg5oh2o/uidact_samp.h~m Attachment S: Aquifer Exemptions If an aquifer exemption is requested, submit data necessary to demonstrate that the aquifer meets the following criteria: (1) does not serve as a source of drinking water; (2) cannot now and will not in the future serve as a source of drinking water; and (3) the TDS content of the ground water is more than 3,000 and less than 10,000 mg/I and is no[ reasonably expected to supply a public water system. Submit data to demonstrate that the aquifer is expected to be mineral or hydrocarbon producing, or can be demonstrated by a permit applicant as part of a permit application for a Class II operation to contain hydrocarbons that considering their quantity and location are expected to be commercially producible. Attachment T: Existing EPA Permits List program and permit number of any existing EPA permits, for example, NPDES, PSD, RCRA, etc. Attachment U: Description of business Give a brief description of the nature of the business, (As an example, the company is involved in the exploration, production, and marketing of crude oil and natural gas). APPENDIX should include the following: I. List of names and addresses of all landowners of record within the 1/4 mile radius area of review of the proposed injection well along with a map showing landowners. 2. Evidence to verify that you have provided the Stale Historic Preservation Office (SHPO) with a topographic map which clearly shows any existing and all proposed road construction or improvement leading up to the site. This information, which is required in order to complete the process of coordination specified in the National Historic Preservation Act, Section 106, should be submitted directly to the State Historic Preservation Office. A copy of the SHPO letter clearing the project must be submitted to the UIC Branch. You may contact SHPO at the following address: Kristine Wilson, Environmental Review Coordinator State Historic Preservation Office Bureau of History 717 West Allegan Street, 5th floor Lansing, Michigan 49918 3. If the proposed well location is in a county that borders the Great Lakes, the owner or operator needs to provide evidence that they have contacted the State Coastal Zone Management Program (CZMP) notifying [hem of [he proposed activity. A copy of the CZMP letter clearing the project must be submitted to the UIC Branch. You may contact CZMP at the following address: Cathy Cunningham, Land and Water Management Analyst Michigan Department of Natural Resources Division of Land and Water Management Coastal Management Program, P.O. Box 30458 Lansing, Michigan 48909 4. Record of state completion and/or plugging for all area of review wells if applicable. 5. An analysis of the physical and chemical characteristics of the injection fluid, along with the description of the source of the injection fluid. The fluid analysis shall include, but not be limited to the following: Sodium, Calcium, Magnesium, Barium, Total Iron, Chloride, Sulfate, Carbonate, 4 of 5 5!28/99 5:37 PM