Oil and Gas Forms

Permit Forms

• §22-6A Horizontal Well Permit Application Forms
• Permit Forms Packet

  For Wells NOT under 22-6A Horizontal Well Act - Revised: May 23.2016
  

• Checklist for Filing Permits

  For Wells NOT under 22-6A Horizontal Well Act​
  

• Coal Bed Methane Permit Pack

  Revised: May 24, 2016

• Plugging Permit

  Revised: May 24, 2016

• WW-4C - Plugging

  Abandoned Well by Interested Party

• OB-13 Coal Objection Form

  Revised: June 18, 2015

• OB-16 - Request to Plug by Coal Operator
• UIC Permit Application Package

  Revised: March 20, 2024

• UIC Well Work Permit Application

  Revised: January 25, 2024

• WR-36

  Oil & Gas Ratio

• WR-37

  Pre Operation Certificate - Revised: December 23, 2019

• WR-38

  Plugging Affidavit

• WW-6

  Well Location Plat

• WW-7

  Well Location Form: GPS

• WW-8

  Site Registration for Land Application of CBM Produced Water - Revised: 08.10.2015

• WW-9

  Pit and Disposal Reclamation Plan - Revised: May 23, 2016

• WW-9-GPP

  Groundwater Protection Plan - Revised: May 24, 2016

• Deep Well Site Safety Plan

  Policy Statement - Revised: November, 2012

• Deep Well Site Safety Plan Outline

  For H6A Well Work Permits and Deep Well Work Permits

• Erosion and Sediment Control Field Manual

  The purpose of this manual is to present the best management practices (BMPs) for controlling erosion and sedimentation from soil-disturbing operations conducted during oil and gas industry activities in the state of West Virginia

Bond Forms

• CD-1

  Certificate of Deposit Bond (CD Bond)

• OP-2

  Request to Invest Bond (Cash Bond)

• Surety Bond instructions
• OP-7

  Single Well Surety Bond​​​
  

• OP-8

  Blanket Surety Bond

• Letter of Credit Bond instructions
• OP-8B

  Letter of Credit (Single Well and Blanket Bond)

Operator Forms

• WR-34

  Discharge Monitoring Report

• WR-35

  Well Record Completion Report

• Instructions for New WR-35 Well Record Completion Report
• WR-39

  Report of Monthly Production - Revised: January, 2019

• WR-39E

  Electronic Production Report - Revised: January, 2017

• WR-40

  Report for Waste Disposal Wells - Revised: 08.05.2014

• WR-99

  Annual Well Inspection Certification - Revised: December, 2015

• WW-72

  Reclamation Notice

• WW-75

  Request not to Bury Pipeline

• BF-1

  Bona Fide Future Use - Revised: December, 2015

• OP-13

  Operator's Annual Inspection Form - Revised: December, 2015

Transfer and Other Forms

• H6A Permit Transfer Package

  OP-6A and WW-6A1PT - New Release: 02.15.2015

• OP-1

  Operator Registration - Revised: February, 2015

• OP-77

  Transfer form - Revised: 04.02.2019

• OP-77A

  Transfer from Unknown Operator - Revised: 01.08.2019​
  

• OP-77U

  UIC Permit Transfer Package

• WW-60

  Royalty Affidavit

• WW-70

  Affidavit of Personal Service