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        Forms

        Underground Injection Control (UIC) Permits
        Form DescriptionRevisionFormat
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        Note: Submission of a complete UIC application consists of a completed Form U200 and completion of the attachments from one of the other forms: U201, U202 or U203. Use the attachment form that applies to your type of UIC well.   

        UIC Form U100: Quarterly Class II Disposal/Injection Well Monitoring Report Form

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        Online

        UIC Form U110: UIC Mechanical Integrity Test Report Form

        05/17

        Online

        UIC Form U111: UIC Mechanical Integrity Test Report - Geothermal

        05/17

        Online

        UIC Form U120: UIC Injection Well Completion Report (Class II/Geothermal)

        05/17

        Online

        UIC Form U200: UIC Permit Application

        05/17

        Online

        UIC Form U201: General Class 5 Well Attachments

        05/17

        Online

        UIC Form U202: Class 2 Oil/Gas, Class 3 Solution Mining, or Class 5 Geothermal Well Attachments

        05/17

        Online

        UIC Form U203: Class 5 Remediation or Tracer Test Attachments

        05/17

        Online

        UIC Form U210: UIC Remediation NOI

        11/17

        Online

        UIC Form U211: Approval Request for Domestic Geothermal Injection Wells

        05/17

        Online

        UIC Form U220: UIC Permit Acknowledgement Form U220

        05/17

        Online

        UIC Form U230: UIC Field Sampling & Monitoring Summary

        05/17

        Online

        UIC Sample List 1

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        Online

        UIC Sample List 2

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        Online

        UIC Sample List 3

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        Online

        UIC Water Sample List – Class 2 wells

        05/17

        Online

        UIC Form U240: UIC Requests for Chemical Use

        05/17

        Online

        UIC Form U250: Notice to Transfer Injection Permit / Change of Ownership

        05/17

        Online

        UIC Form U310: UIC Notice of Termination

        10/16

        Online

        Discharge Basin Form - Associated with UIC Permit

        05/17

        Online

        Oil/Water Separator Notice of Intent (NOI)

        05/17

        Online

        Injection Well Notification Form

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        Online

        Class V Well Pre-closure Notification Form

        05/17

        Online

        Requests for Tracer Use in Ground Water

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        Online

        UIC Permit Cancellation Guidance

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        Newsletter Signup: Water Pollution

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