1. FORM 1000B – APPLICATION TO DRILL DEEP ANODE GROUNDBED

2. This presentation will assist you in the completion of the Form 1000b. The application to drill deep anode groundbed. Date of Last Revision: 2007. Rule Requirement: OAC 165:10-7-14 Explanation of Form: Form 1000B is required to be filed for wells drilled for deep anode groundbeds as required by OAC 165:10-7-14. The purpose of Commission Form 1000B is to ensure groundwater is being protected in construction of the deep anode groundbed. [Reference 165:10-7-14] Question concerning this Form: Contact Pollution Abatement at (405) 522-2763.

3. FORM 1000B – APPLICATION TO DRILL DEEP ANODE GROUNDBED WELL LOCATION: be sure to include the quarter section calls. Contact Pollution Abatement as they have a special pamphlet on how to find this information.

4. FORM 1000B – APPLICATION TO DRILL DEEP ANODE GROUNDBED PLOT WELL LOCATION: make sure this matches the quarter section calls in the well location section.

5. FORM 1000B – APPLICATION TO DRILL DEEP ANODE GROUNDBED OPERATOR

6. FORM 1000B – APPLICATION TO DRILL DEEP ANODE GROUNDBED CONTRACTOR

7. FORM 1000B – APPLICATION TO DRILL DEEP ANODE GROUNDBED SKETCH SUBSURFACE FACILITIES

8. FORM 1000B – APPLICATION TO DRILL DEEP ANODE GROUNDBED DEEP ANODE GROUNDBED (D.A.G.): This is for OCC use only. BASE OF TREATABLE WATER: This will be supplied by Geology Department of the OCC – Leave Blank.

9. FORM 1000B – APPLICATION TO DRILL DEEP ANODE GROUNDBED SIGNATURE BLOCK

10. FORM 1000B – APPLICATION TO DRILL DEEP ANODE GROUNDBED OCC USE ONLY – Do Not Write in this Box

11. FORM 1000B – APPLICATION TO DRILL DEEP ANODE GROUNDBED INSTRUCTIONS FOR COMPLETING THE D.A.G.