1. FORM 1072 – NOTICE OF TERMINATION

2. FORM 1072 – NOTICE OF TERMINATION
This presentation will assist you in the completion of the Form The notice of termination.
Date of Last Revision: 2010
Rule Requirement: OAC 165:10-5-7a
Explanation of Form: Within 30 days of the termination of injection Form 1072 must be filed. [Reference 165:10-5-7]
Question concerning this Form: For more information contact Pollution Abatement at (405)

3. FORM 1072 – NOTICE OF TERMINATION
OPERATOR – Name of Operator

4. FORM 1072 – NOTICE OF TERMINATION
OPERATOR – OCC/OTC OPERATOR NUMBER

5. FORM 1072 – NOTICE OF TERMINATION
OPERATOR – Mailing Address, Phone Number, City, State, Zip Code, and Fax Number along with an Address if available

6. FORM 1072 – NOTICE OF TERMINATION
WELL NAME AND NUMBER

7. FORM 1072 – NOTICE OF TERMINATION
API NUMBER OF THE WELL

8. FORM 1072 – NOTICE OF TERMINATION
LEGAL LOCATION OF THE WELL – Quarter Section Calls, Section, Township, and Range along with the County in which the well resides

9. FORM 1072 – NOTICE OF TERMINATION
WELL CLASSIFICATION - Is the well?
- a Disposal Well
- an Enhanced Recovery Injection
Well
- an Enhance Recovery Project

10. FORM 1072 – NOTICE OF TERMINATION
USE THE MOST CURRENT ORDER/PERMIT AUTHORIZING INJECTION NUMBER

11. FORM 1072 – NOTICE OF TERMINATION
DATE THE ORDER/PERMIT WAS ISSUED

12. FORM 1072 – NOTICE OF TERMINATION
INJECTION ZONE

13. FORM 1072 – NOTICE OF TERMINATION
REASON FOR TERMINATION:
Well to be:
- Plugged
- Returned to Production
- Producing Interval
- Temporarily Abandoned
- Converting to New Permit
Application Number
Application Date

14. FORM 1072 – NOTICE OF TERMINATION
SIGNATURE BLOCK OF OPERATOR