Laserfiche WebLink
Nc. 7000.OOe7. <br />/~ WASHINGTON. DC 7Ma0 <br />v E PA ANNUAL. DISPOSAL/INJECTION WEII MONITORING REPORT <br />NAME AND ADDRESb Of E%4TING PfpMRTEE NAME AND ADDRESS OF bURFACE OWNER <br /> <br />LOLATE WELL AND O <br />SECTION PLAT - 6 <br />UTLINE UNfT ON <br />a0 ACRES bTATE COUNTY PEFMrt NUMBER <br /> <br />N SURFACE LOGTKIN OEbCRIPf10N <br />F Y OF K bF C110N TOWNSHIP RAN <br />E <br /> x O <br />G <br /> LOCATE WELL IN TWO DIFECTIONS IFOM NV FEST LINES Of OUAFTEp SECTION AND DRILLING UNn <br /> burfaw <br />Lin. a ewn« ..akn <br />ri <br />n; <br />fiom IN/SI <br />L <br /> T ~~- <br />~~~ cu <br />on _ <br />. <br />- <br />eM ~ fi. fiom E - line a cen« iMlOn <br /> I I I ~ I <br />E WELL ACTIVf1Y TYPE OF PERMR <br />I7 Brine Diaporil OlrWividual <br />W <br />1 ^ E nnenoso Recovery ^ Area <br />O Hycroceroon Swope Number o1 Wells <br /> ' ( I I I <br />t"-}-t lease Name Well Number <br /> t <br /> <br />TUEING -USING PNNULUb PRESSURE <br />INJfCTiON PRFbSURE TOTAL VOLUME INJE:7ED (OPTIONAL MONRORMG) <br />MONTFI YEAR AVE FAGS PS1G MAaIMUM PSIG BBL MCT MINIMUM pSIG MAXIMUM PSIG <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />CERTIFICATION <br />l certify under the penalty offs w that 1 have personally examined snd am familiar with the information submitted in <br />this document and sl/attachments and that, based on my inquiry of those individuals immediately respohsib/e for <br />obtaining the information, /believe that the information is true, accurate, and complete. lam aware that there e-e <br />significant penehies for submitting false information, including the possibility of fine and imprisonment. (Ref. 40 <br />CfA 144.32] <br />NAME AND OffIC1Al MlE /Phase type w prrnry bIGNATURE DATE 51G ED <br />