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Underground Injection Control - Technical Information, Forms and Sample Documents
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U.S. EPA Underground Injection Control (UIC) personnel at Headquarters, the UIC National Technical Workgroup and the Region 5 UIC office have prepared documents related to technical issues for the UIC Program. In addition, other technical information relevant to the UIC program are included below.
Technical Information
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Forms and Sample Documents
- Example Permit Application & Other Permit Documents
- Federal & State Program Performance Summary Forms (7520s)
- Forms for Class V Well Owner/Operators
- Forms for Owner/Operator of other classes of wells
- Sample Financial Forms
- Sample Monitoring Reports & Other Forms
Staff members are also available to answer questions
UIC Materials on the US EPA Drinking Water Academy (DWA) website
| Adobe Acrobat PDF files |
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| Introduction to the UIC Program PDF (65 pp, 2.1Mb) |
| Introduction to UIC Permitting (Part 1) PDF (73 pp, 3.1Mb) |
| Introduction to UIC Permitting (Part 2) PDF (229 pp, 2.5Mb) |
| The Nuts and Bolts of Falloff Testing (2003) PDF (208 pp, 3.4Mb) |
Drinking Water Academy UIC training web page
Glossaries
| Glossaries |
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| EPA UIC Glossary of UIC Terms |
| Region 5 UIC Glossary of UIC Terms |
Example Permit Application & Other Permit Documents
| EPA UIC Permit Application Form (PDF) (6 pp, 100 K) |
| Federal Financial Responsibility Demonstrations for Owners and Operators of Class II Oil- and Gas-Related Injection Wells (PDF) (29 pp, 688 K) (EPA 570/9-90-003) |
| Types of Financial Assurance Mechanisms (HTML) |
| Region 5 UIC Class I Permit Application Checklist (PDF) (5 pp, 73 K) |
| Region 5 UIC Class I Permit Re-Application Guidelines (PDF) (1 p, 8 K) |
| Region 5 UIC Class II Technical Review Sheet (PDF) (5 pp, 22 K) |
| Region 5 UIC Example Class II Permit Application (PDF) (9 pp, 2.7 M) |
| Region 5 UIC Class V Permit Application Instructions (HTML) |
| Region 5 UIC Permit Extension Instructions (HTML) |
| Region 5 UIC Plugging and Abandonment Cost Estimate Worksheet PDF
(3 pp, 29 K) Also available in Microsoft Excel format cost_estimate_worksheet.xls (40K) |
| Region 5 UIC Requirements for Commercial Underground Injection Control Class II Wells (HTML) |
| State Historic Preservation Office Letter (PDF) (1 p, 51 K) |
| Region 5 UIC Transfer of Ownership Requirements (PDF) (1 p, 15 K) |
| Wellbore Schematic (MicroSoft Excel file to submit with Plugging and Abandonment Plan) (1 p, 23 K) |
Sample UIC Financial Forms
The UIC Program has prepared sample documents to make it simpler for applicants and permittees to meet certain requirements. You may view or download an Adobe PDF version and fill it in on a typewriter or you may download either a WordPerfect or Microsoft Word version of these files and complete them on your computer. (More recent versions of word processing software should have no problem reading these files saved using the older releases.) The financial forms are samples: comparable wording is usually acceptable. Forms will be added as they become available.
In addition, a simple discussion of the different types of financial mechanisms and their requirements is available.
| Amendment to Standby Trust Agreement (PDF) (1 p, 10 K) |
| Amendment to Trust Agreement (PDF) (1 p, 27 K) |
| Auditor's Verification of Chief Financial Officer's Letter (PDF) (1 p, 7 K) |
| Certificate of Acknowledgment (PDF) (1 pp, 22KB) (for Standby Trust Agreement) |
| Chief Financial Officer's Letter for Class I Wells (PDF) (2 pp, 13 K) |
| Chief Financial Officer's Letter for Class II Wells (PDF) (3 pp, 14 K) |
| Exhibit A (PDF) (1 pp, 20KB) (for Standby Trust Agreement) |
| Form VII-10 (PDF) (for Blanket Bond Coverage) (1 pp, 55 K) |
| Irrevocable Standby Letter of Credit (PDF) (2 pp, 31KB) |
| Letter Requesting Use of Michigan State Bond (PDF) (1 p, 13 K) |
| Schedule A (PDF) (1 pp, 13KB) (for Standby Trust Agreement) |
| Standby Trust Agreement (PDF) (6 pp, 57KB) |
| Surety Performance Bond (PDF) (4 pp, 37K) |
| Trust Agreement (PDF) (9 pp, 23 K) |
| Plugging and Abandonment Cost Estimate Worksheet PDF
(3 pp, 29 K) Also available in Microsoft Excel format cost_estimate_worksheet.xls (40K) |
Class V Forms
Inventory Information
If you have a Class V well, it is your responsibility to submit inventory information. We have prepared an inventory sheet with instructions to make it simpler for well owners and operators. You may download either a WordPerfect Version 5 or Word97 version of these files or view them onscreen. (More recent versions of word processing software should have no problem reading these files saved using the older releases.)| Region 5 Class V Inventory Sheet (PDF) (1 p, 45 K) |
| Instructions for Region 5 Class V Inventory Sheet (PDF) (1 p, 47 K) |
Pre-Closure Information
Note: Owners/Operators must submit Pre-Closure Notification forms before closing a Motor Vehicle Waste Disposal Well. See Closure Guidelines for Facilities with Motor Vehicle Waste Disposal Wells (PDF) (2pp, 11K) for more information.| Pre-Closure Notification Form & Instructions (PDF) (2 pp, 59 K) |
| Forma de Notificación Antes de Clausura Para Posos de Clase V y
Instrucciónes (Pre-Closure Notification Form and Instructions in Spanish) |
Forma de Notificación Antes de Clausura
Para Posos de Clase V (PDF) (1 p, 21 K,
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| Forma de Notificación Antes de Clausura
Para Posos de Clase V:Instrucciónes (PDF) (1 p, 20 K,
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| (A volver a página de el nuevo reglamento de talleres) |
Some Class V wells will require a permit. In these cases, the owner/operator must submit a permit application.
Sample Monitoring Reports and Other Forms
| Sample Monthly Monitoring Form (PDF) (1 p, 39 K) |
| Sample Quarterly Monitoring Form (PDF) (1 p, 16 K) |
| Sample Annual Monitoring Form (PDF) (1 p, 9 K) |
| Form to Report Unwitnessed Mechanical Integrity Test (PDF) (1 p, 38 K) |
| Instructions for Unwitnessed Mechanical Integrity Tests (PDF) (2 pp, 24 K) |
Underground Injection Control Topics | Other Local Water Topics