Form Uic 13 – Fill Out and Use This PDF

The UIC-13 form is a required application for operators seeking approval to use a community saltwater disposal system in Louisiana. This document gathers essential information about the operator, the disposal well, and the source of the fluid, ensuring a comprehensive review by the Office of Conservation Injection and Mining Division. If you're looking to apply for permission to utilize a community disposal well, click the button below to get started on filling out your UIC-13 form.

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Form Uic 13 PDF Details

Navigating the complexities of managing saltwater disposal in Louisiana is streamlined with the UIC-13 form, devised for operators seeking to utilize community saltwater disposal systems. This comprehensive application, rooted in ensuring environmental protection and operational efficiency, is a critical step mandated by the Office of Conservation Injection and Mining Division, located in Baton Rouge, LA. The form requires detailed operator information, including names, contact details, and specifics about the disposal well such as its name, location, and the source of the fluid intended for disposal. It also mandates listing each producing well contributing to the community system, paired with an account of the transportation method—whether by truck, pipeline, or other means. This ensures a thorough review and verification process, highlighting the importance of accuracy and completeness in submissions, backed by the endorsement of the operator through a certification that emphasizes the non-commercial nature of the operation, aimed solely at sharing operational and maintenance costs among users. Essential attachments include operating agreements with every operator aiming to utilize the community disposal well, ensuring mutual consent and compliance. This safeguarding measure, coupled with a non-refundable application fee and precise instructions for submission, ensures that only thoroughly vetted and compliant applications are considered, mirroring the state’s commitment to maintaining environmental standards while facilitating saltwater disposal operations.

Question	Answer
Form Name	Form Uic 13
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	UIC13 salt water disposal agreement form

Form Preview Example

COMMUNITY SALTWATER DISPOSAL SYSTEM APPLICATION

MAILING ADDRESS: OFFICE OF CONSERVATION INJECTION & MINING DIVISION P.O. BOX 94275-CAPITOL STATION BATON ROUGE, LA 70804-9275

PHYSICAL ADDRESS: OFFICE OF CONSERVATION INJECTION & MINING DIVISION 617 N. THIRD ST., SUITE 817 BATON ROUGE, LA 70802

UIC-13

PLEASE READ APPLICATION PROCEDURES

TYPE ONLY

OPERATOR INFORMATION

1.	OPERATOR NAME:				2. OPERATOR CODE:
	ADDRESS:
	CITY, STATE, ZIP:	,
	CITY, STATE, ZIP:	,			3.	PHONE:		FAX:
					3.	PHONE:		FAX:
	EMAIL:

				WELL INFORMATION

4.	PROPOSED COMMUNITY WELL NAME AND NUMBER:				5.	SERIAL NO. (CONVERSION & RE-PERMIT ONLY)
	WELL NO.

6.	FIELD:		7. PARISH:		8.	SEC.	TWP.		RNG.

FLUID SOURCE LIST

Provide the following information for each producing well that will be utilizing the above-listed community disposal well and system. Check if continue on back:

OPERATOR

WELL NAME & NO.

SERIAL NO. BBL SW/ MO.

TRANSPORTATION BY
TRUCK	PIPELINE	OTHER

CERTIFICATION BY OPERATOR

I	(COMPANY OFFICIAL)	,	(TITLE)	,

hereby certify that the information contained herein is accuratE and complete to the best of my knowledge. I further certify that the community disposal well(s) and system identified above is a noncommercial operation and that operators using the system share only in the cost of operating and maintaining the well(s), related storage tanks, and equipment. Attached to this document are copies of operating agreements with each of the operators wanting to utilize the above-referenced well for disposal of produced saltwater.

10.	NAME (PRINT):		11.	PHONE:
12.	SIGNATURE:	13.		DATE:

FORM UIC-13

http://dnr.louisiana.gov/cons/documents.ssi

Rev. 07/09

INSTRUCTIONS

1.Submit the non-refundable application fee per LAC 43:XIX.Chapter 7.

2.Form UIC-13 must be completed and submitted to the Injection and Mining Division for review and approval before a well may be utilized as a Community Saltwater Disposal Well.

3.For each producing well identified in the Fluid Source List, indicate which method of transportation is used to transport the saltwater to the community well.

4.Sign and date the certification at the bottom of the form prior to mailing to the following address:

Office of Conservation

Injection and Mining Division

P O Box 94275

Baton Rouge, Louisiana 70804-9275

5.Attach a copy of each operating agreement for each operator wishing to utilize the community disposal well and system. Each agreement must be signed by both parties.

* * * * * * * * * * * * * * * * * * *

(Continued from front)

OPERATOR

WELL NAME & NO.

SERIAL NO.

BBL SW/ MO.

TRANSPORTATION BY

TRUCK

PIPELINE

OTHER