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PAPERWORK REDUCTION ACT
<br />The public reporting and record keeping burden for this collection of information is estimated to average 49 hours per response for a Class I
<br />hazardous facility, and 47 hours per response for a Class I non - hazardous facility. Burden means the total time, effort, or financial resource
<br />expended by persons to generate, maintain, retain, or disclose or provide information to or for a Federal Agency. This includesthe time needed
<br />to review instructions develop, acquire, install, and utilize technology and systems for the purposes of collecting, validating, and verifying
<br />information, processing and maintaining information, and disclosing and providing Information; adjust the existing ways to comply with any
<br />previously applicable instructions and requirements; train personnel to be able to respond to the collection of information; search data sources;
<br />complete and review the collection of information; and, transmit or otherwise disclose the information. An agency may not conduct or sponsor,
<br />and a person is not required to respond to, a collection of information unless It displays a currently valid OMB control number. Send comments
<br />on the Agency's need for this Information, the accuracy of the provided burden estimates, and any suggested methods for minimizing
<br />respondent burden, including the use of automated collection techniques to Director, Collection Strategies Division, U.S. Environmental Protection
<br />Agency (2822), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send
<br />the completed forms to this address.
<br />I. Geologic Information
<br />1. Lithology and Stratigraphy
<br />B. Provide a description of the injection unit.
<br />(1) Name
<br />(2) Depth (drilled)
<br />(3) Thickness
<br />(4) Formation fluid pressure
<br />(5) Age of unit
<br />(6) Porosity (avg.)
<br />(7) Permeability
<br />(8) Bottom hole temperature
<br />(9) Lithology
<br />(10) Bottom hold pressure
<br />(11) Fracture pressure
<br />II. Well Design and Construction
<br />Attachments to be submitted with the Completion report:
<br />A. Provide a geologic description of the rock units pene-
<br />trated by name, age, depth, thickness, and lithology of
<br />each rock unit penetrated.
<br />C. Provide chemical characteristics of formation fluid
<br />(attach chemical analysis).
<br />D. Provide a description of freshwater aquifers.
<br />(1) Depth to base of fresh - water -(less than 10,000 - mg /I-
<br />TDS).
<br />(2) Provide a geologic description of aquifer units with
<br />name, age, depth, thickness, lithology, and average total
<br />dissolved solids.
<br />1. Provide data on surface, intermediate, and long string
<br />casing and tubing. Data must include material, size,
<br />weight, grade, and depth set.
<br />2. Provide data on the well cement, such as type /class,
<br />additives, amount, and method of emplacement.
<br />3. Provide packer data on the packer (if used) such as
<br />type, name and model, setting depth, and type of annular
<br />fluid used.
<br />EPA Form 7520 -9 Reverse
<br />4. Provide data on centralizers to include number, type
<br />and depth.
<br />5. Provide data on bottom hole completions.
<br />6. Provide data on well stimulation used.
<br />III. Description of Surface Equipment
<br />1. Provide data and a sketch of holding tanks, flow lines,
<br />filters, and injection pump.
<br />IV. Monitoring Systems
<br />1. Provide data on recording and nonrecording injection
<br />pressure gauges, casing- tubing annulus pressure
<br />gauges, injection rate meters, temperature meters, and
<br />other meters or gauges.
<br />2. Provide data on constructed monitor wells such as
<br />location, depth, casing diameter, method of cementing,
<br />etc.
<br />V. Logging and Testing Results
<br />Provide a descriptive report interpreting the results of
<br />geophysical logs and other tests. Include a description
<br />and data on deviation - checks _run during_ drilling..
<br />VI. Provide an as -built diagrammatic sketch of the injec-
<br />tion well(s) showing casing, cement, tubing, packer, etc.,
<br />with proper setting depths. The sketch should include
<br />well head and gauges.
<br />VII. Provide data demonstrating mechanical integrity
<br />pursuant to 40 CFR 146.08.
<br />VIII. Report on the compatibility of injected wastes with
<br />fluids and minerals in both the injection zone and the
<br />confining zone.
<br />IX. Report the status of corrective action on defective
<br />wells in the area of review.
<br />X. Include the anticipated maximum pressure and flow
<br />rate at which injection will operate.
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