1. FORM 1014D – APPLICATION FOR SURFACE DISCHARGE

2. 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:
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: or 165: ]
Question concerning this Form: For more information contact Pollution Abatement at (405)

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

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

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

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

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

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

9. FORM 1014D – APPLICATION FOR SURFACE DISCHARGE
LOCATION WITHIN SECTION

10. FORM 1014D – APPLICATION FOR SURFACE DISCHARGE
COUNTY

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

12. FORM 1014D – APPLICATION FOR SURFACE DISCHARGE
COUNTY

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

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

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

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

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

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

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

20. FORM 1014D – APPLICATION FOR SURFACE DISCHARGE
POTENTIAL DISCHARGE AREA

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

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

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

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

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

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

27. FORM 1014D – APPLICATION FOR SURFACE DISCHARGE
SOIL ANALYSIS ATTACHED

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

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

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

31. FORM 1014D – APPLICATION FOR SURFACE DISCHARGE
NOTARY SIGNATURE BLOCK

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

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