Michigan Geological Survey
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 7200-15MW(single)

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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