Oil, Gas, and Minerals Division - Mineral Well Forms Page

Contact: Oil, Gas, and Minerals Division 517-284-6826

Download all Mineral Well Forms in zipped file (approximately 650 Kb).   

Forms on this page are in Micosoft Word format.   
(Adobe format forms are available upon request)

Items on this page:
Forms used for Permits and Bonding (PBU)
Forms used for Drilling and Completion (PMGU)
Forms used for Production and Operating (PMGU and MPSC)

Forms Used by District Office (District and Area Geologists)


Forms Used for Permits and Bonding
Permit Applications may be submitted by mail to:

Michigan Department of Environmental Quality
Oil, Gas, and Minerals Division
P.O. Box 30256 Lansing, Michigan 48909-7756

or by email to:DEQ-OOGMpermitapplications@michigan.gov
Contact: 517-284-6826 

FORM NAME 

FORM NUMBER 

ORIGINATOR  

WHEN TO FILE 

WHERE TO FILE

*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 7200-2
EQC 7200-3
EQC 7200-4
EQC 7200-5

Permit Applicant

Application

PBU

*Survey Record of Well Location

EQP 7200-2

Permit Applicant

w/ Application for Permit to Drill

PBU

*Wellhead Blowout Control System

EQP 7200-4

Permit Applicant

w/ Application for Permit to Drill

PBU

*Injection Well Data & Attachments

EQP 7200-14

Permit Applicant

w/ Application for Permit to Drill Injection Well or ACOWS

PBU

*Soil Erosion & Sedimentation Control Plan & attachments

EQP 7200-18

Permit Applicant

w/ Application for Permit to Drill

PBU

*Environmental Impact Assessment for Mineral Wells and Surface Facilities

EQP 7500-3

Permit Applicant

w/ Application for Permit to Drill

PBU

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 OOGM do not need to be copied for new applications

PBU

  1. Surety

EQP 7200-3MW

  1. Certificate of Deposit

CD

  1. Letter of Credit

EQP 7598 single
EQP 7599 blanket

  1. Cashier's Check

check

  1. Statement of Financial Responsibility

EQP 7200-17MW

IRS form W-9 Request for Taxpayer Identification Number and Certification

Form W-9

Permit Applicant

w/CD bond

Budget Unit

Acceptance of CD as Performance Bond

EQP 7200-15MW (single)

EQP 7200-16 MW (blanket)

Permit Applicant

w/CD bond

PBU

Well Permittee Organization Report

EQP 7200-13

Permit Applicant

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

PBU

Request for Transfer of Permit

EQP 7200-7

Permittee

At change of owner or operator

PBU

COMPLETION AND DRILLING FORMS

FORM NAME

FORM NUMBER 

ORIGINATOR 

WHEN TO FILE 

WHERE TO FILE

Record of Well Drilling or Deepening

EQP 7200-5

Permittee

Within 60 days of drilling completion

PMGU

Well Elevations

No form.
File as required by  {R299.2369}

Permittee

Within 60 days of drilling completion

PMGU

Electric or Radiation Logs

No form.
File as required by  {R299.2370}

Permittee

30 days after running log(s)

PMGU

Survey of Directionally Drilled Well

No form.
File as required by  {R299.2371}

Permittee

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

PMGU

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

EQP 7200-10

Permittee

30 days after water well completion

DO

Certification of Casing and Sealing of Surface Hole

EQP 7200-12

Permittee

30 days after drilling completion

PMGU

Mud Pit Plot

EQP 7200-9

Permittee

60 days after drilling completion

DO

Record of Well Completion

EQP 7130

Permittee

Within 60 days of drilling completion

PMGU

Core descriptions

No form.
File record as required by {R299.2369}

Permittee

Within 60 days of drilling completion

PMGU

Application to Change Well Status and/or Plug and Abandon

EQP 7200-6

Permittee

Before start of operation

DO

Record of Well Plugging or Change of Well Status

EQP 7200-8

Permittee

30 days after Change/Plugging

DO

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

EQP 7200-11

Drilling Contractor

Annually or when BOP is modified

PBU

PRODUCTION AND OPERATING FORMS

FORM NAME 

FORM NUMBER

ORIGINATOR 

WHEN TO FILE 

WHERE TO FILE 

Bottom Hole Pressure Test

EQP 7104

Permittee

After completion and as requested

PMGU

Monthly Operating Report - Deep Well Injection

EQP 7215

Permittee

Monthly

PMGU

Annual Mineral Well Regulatory Fee Assessment Report

EQP 7140

Permittee

Annually

PMGU

Liquid and Gas Analysis

---

Permittee

After completion and as requested

PMGU

Annular Pressure Test

EQP 7606

Permittee

per R299.2391 and R299.2393

PMGU