FORM 1014D – APPLICATION FOR SURFACE DISCHARGE

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Presentation transcript:

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE This presentation will assist you in the completion of the Form 1014D. The application for surface discharge. Date of Last Revision: 2001 Rule Requirement: 10-7-17 Explanation of Form: Each application for surface discharge of produced water or for reclaiming and/or recycling of produced water must be submitted to the appropriate Conservation Division District Office on Form 1014D in quadruplicate. Applications will be processed within five working days. [Reference 165:10-7-17 or 165:10-7-32] Question concerning this Form: For more information contact Pollution Abatement at (405) 522-2763

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE OCC LOG-IN NUMBER – Do not write in this space, OCC use only.

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE NAME OF THE OPERATOR

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE OTC/OCC OPERATOR NUMBER (if one has been assigned)

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE ADDRESS, PHONE NUMBER, CITY, STATE, ZIP CODE AND FAX NUMBER

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE WELL NAME AND NUMBER or Pipeline Company

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE API NUMBER (if one has been assigned)

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE LOCATION WITHIN SECTION

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE COUNTY

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE SURFACE DISCHARGE AREA WITHIN THE SECTION

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE COUNTY

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE WAS DISTRICT OFFICE CONTACTED TO WITNESS SAMPLING (if applicable)

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE MAXIMUM VOLUME TO BE DISCHARGED AT ONE TIME IN NUMBER OF BARRELS

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE IS DISCHARGE MORE THAN 50 FEET FROM A STREAM

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE IS DISCHARGE MORE THAN 300 FEET FROM AN ACTIVELY-PRODUCING DOMESTIC OR IRRIGATION WATER WELL

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE IS DISCHARGE MORE THAN 800 FEET TO AN ACTIVELY PRODUCING MUNICIPAL WATER WELL

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE METHOD OF APPLICATION: SPRAY IRRIGATION GUN OR OTHER

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE NUMBER OF ACRES IN PROPOSED DISCHARGE AREA

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE POTENTIAL DISCHARGE AREA

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE COPY OF THIS NOTICE TO THE SURFACE OWNER

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE COPY OF CONTACT OR AFFIDAVIT ATTACHED (required only if operator has a contractor or agent)

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE MAP OR DIAGRAM, DRAWN TO SCALE, SHOWING PROPOSED AND POTENTIAL DISCHARGE AREAS ATTACHED.

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE SITE SUITABILITY REPORT ATTACHED (if required)

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE PRODUCED WATER ANALYSIS ATTACHED

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE PRODUCED WATER ANALYSIS WAS EXEMPT BY FIELD OPERATIONS (attach documentation)

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE SOIL ANALYSIS ATTACHED

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE SOIL ANALYSIS WAS EXEMPT BY FIELD OPERATIONS (attach documentation)

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE OTHER ATTACHMENTS – LIST AND DESCRIBE AND ATTACH

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE DATE OF EXECUTION AND SIGNATURE

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE NOTARY SIGNATURE BLOCK

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE INSTRUCTIONS FOR COMPLETING THIS FORM

FORM 1014D – APPLICATION FOR SURFACE DISCHARGE OCC USE ONLY – Do Not Write in this Space