Office of Oil, Gas and Minerals
FORMS USED FOR MINERAL WELLS 

Download all  Mineral Well forms in zipped file (approx 650 Kb).   
Most of the forms on this page are in Microsoft Word format, a few are in Acrobat. 
To order paper forms, call 517-241-1515. 

1/27/2005: All the forms in this download can have data entered in them from the computer, if you can call it up in Microsoft Word, you can enter data from Microsoft Word.  Previously, some of the forms had to be printed out and filled in by hand or typewriter. 

Forms for  Permits and Bonds 
Forms for  Drilling and Completion 
Forms for  Production and Operating 

Forms for PERMITS AND BONDS 

Form Name 

Form No. 

Who Originates 

When Filed 

Where Filed 

No. of Copies with Original 

*Application for Permit to Drill/Deepen/Convert, and Operate a Well
Forms marked w/ * are attached as part of a complete application to drill 

EQP 7200-1 

Permit Instructions:
EQC 7200
EQC 7200-1
EQC 7200-4
EQC 7200-5 

Permit Applicant 

Application 

PBU 

5 
(3 sets: 1 orig of complete app + 2 sets of copies + 3 copies of EQP 7200-1) 

*Survey Record of Well Location 

EQP 7200-2 

Permit Applicant 

w/ Application for Permit to Drill 

PBU 

2 

*Wellhead Blowout Control System 

EQP 7200-4 

Permit Applicant 

w/ Application for Permit to Drill 

PBU 

2 

*Injection Well Data & attachments 

EQP 7200-14 

Permit Applicant 

w/ Application for Permit to Drill Injection Well or ACOWS 

PBU 

2 

*Soil Erosion & Sedimentation Control Plan & attachments 

EQP 7200-18 

Permit Applicant 

w/ Application for Permit to Drill 

PBU 

2 

*Environmental Impact Assessment for Mineral Wells and Surface Facilities 

EQP 7500-3 

Permit Applicant 

w/ Application for Permit to Drill 

PBU 

2 

Bond for Conformance
(use one of the below) 

Permit Applicant 

If for a single well- 

w/ Application for Permit to Drill or Request for Transfer 

Blanket bond docs already on file at GSD do not need to be copied for new applications 

PBU 

0 

1. Surety 

1.EQP 7200-3MW  

2. Certificate of Deposit 

2. CD 

3. Letter of Credit 

3. EQP 7598single
3. EQP 7599blanket 

4. Cashier's Check 

4. check 

5. Statement of Financial Responsibility 

5.EQP 7200-17MW   

IRS form W-9 

Request for Taxpayer Identification Number and Certification 

Form W-9 

Permit Applicant 

w/ CD bond 

Budget Unit 

0 

Acceptance of CD as Performance Bond 

EQP 7200-16 MW(blanket)  

Permit Applicant 

w/ CD bond 

PBU 

0 

Well Permittee Organization Report 

EQP 7200-13 

Permit Applicant 

As requested by PB Unit: usually w/App or Request for Transfer 

PBU 

1 

Permit to Drill/Deepen/Convert and Operate a Mineral Well 

EQP 7200 M 

PB Unit 

When issued 

--- 

1 canary- "original" and 3 "colored" copies 

Request for Transfer of Permit 

EQP 7200-7 

Permittee 

At change of owner or operator 

PBU 

3 

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Forms for  COMPLETION AND DRILLING 

Form Name 

Form No. 

Who Originates 

When Filed 

Where Filed 

No. of Copies with Original 

Record of Well Drilling or Deepening 

EQP 7200-5 

Permittee 

Within 60 days of drilling completion 

MGW 

3 

Well Elevations 

--- 

Permittee 

Within 60 days of drilling completion 

MGW 

0 

Electric or Radiation Logs 

--- 

Permittee 

30 days after running log(s) 

MGW 

0 

Survey of Directionally Drilled Well 

--- 

Permittee 

30 days after drilling completion Note:  a well may not be produced until survey is filed 

MGW 

3 

Water Well Record for Oil, Gas, or Mineral Well Operations 

EQP 7200-10 

Permittee 

30 days after water well completion 

DO 

3 

Certification of Casing and Sealing of Surface Hole 

EQP-7200-12 

Permittee 

30 days after drilling completion 

MGW 

1 

Mud Pit Plot 

EQP 7200-9 

Permittee 

60 days after drilling completion 

DO 

1 

Record of Well Completion 

EQP 7130 

Permittee 

Within 60 days of drilling completion 

MGW 

3 

Core descriptions 

--- 

Permittee 

Within 60 days of drilling completion 

MGW 

0 

Application to Change Well Status 

EQP 7200-6 

Permittee 

Before start of operation 

DO 

3 

Application to Plug and Abandon 

EQP 7200-6 

(same form as above) 

District 

When requested by permittee or GSD Compliance Unit 

Mailed to Permittee 

3 

Record of Well Plugging or Change of Well Status 

EQP 7200-8 

Permittee 

30 days after Change/Plugging 

DO 

3 

Annual Certification for Blowout Preventers, Accumulators, Pumps and Secondary Systems 

EQP 7200-11 

Drilling Contractor 

Annually or when BOP is modified 

PBU 

0 

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Forms for  PRODUCTION AND OPERATING 

Form Name 

Form No. 

Who Originates 

When Filed 

Where Filed 

No. of Copies with Original 

Bottom Hole Pressure Test 

EQP 7104 

Permittee 

After completion and as requested 

MGW 

0 

Monthly Operating Report--Deep Well Injection 

EQP 7215 

Permittee 

Monthly 

MGW 

0 

0 

Liquid and Gas Analysis 

--- 

Permittee 

After completion and as requested 

MGW 

0 

Annular Pressure Test 

    Typically not used for Part 625 injection     wells, but could be used. 

EQP 7606 

Permittee 

per R324.803 and 805 

Before initial injection and at least once each 5 years 

MGW 

0 

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