7520-3 Inspections and MIT

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United States Environmental Protection Agency
Office of Ground Water and Drinking Water
Washington, DC 20460

OMB No. 2040-0042

Approval Expires 4/30/07

I. Name and Address of Reporting Agency

United States Environmental Protection Agency

UIC Federal Reporting System

Part III: Inspections
Mechanical Integrity Testing
(This information is solicited under the
authority of the Safe Drinking Water Act)
II. Date Prepared (month, day, year)

III. State Contact (name, telephone no.)

IV. Reporting Period (month, year)
From

To

October 1, 20
Class and Type of Injection Wells
II
Item
Total
Wells

A

V.
Summary
Total
of

Inspections

B

Inspections

A
Total
Wells

B

For
Significant

of

Leak

Integrity

For
Fluid

Total
Wells

A

VII.

of
Remedial
Action

2R

2H

III

IV

V

1. Number of Mechanical Integrity Tests
(MIT) Witnessed
2. Number of Emergency Response or
Complaint Response Inspections
3. Number of Well
Constructions Witnessed
4. Number of Well
Pluggings Witnessed
5. Number of Routine/Periodic
Inspections
Number of Wells Tested or Evaluated
for Mechanical Integrity (MI)
No. of Rule-Authorized Wells Passed 2-part test
Tested/Evaluated for MI
Failed 2-part test

Total
Remedial
Actions

VIII. Remarks/Ad Hoc Report

2. No. of Casing/
Tubing Pressure Tests

Well Passed

3. Number of Monitoring
Record Evaluations

Well Passed

4. No. of Other Significant Leak
Tests/Evaluations (Specify)

Well Passed

1. Number of Cement
Record Evaluations

Well Passed

2. Number of Temperature/
Noise Log Tests

Well Passed

3. No. of Radioactive Tracer/
Cement Bond Tests

Well Passed

4. No. of Other Fluid Migration
Tests/Evaluations (Specify)

Well Passed

D

Migration

Summary

HC

2D

Number of Wells Inspected

C

Mechanical

(MI)

ER

Well Passed
1. Number of Annulus Pressure
Monitoring Record Evaluations Well Failed

VI.

Summary

I

SWD

B

Well Failed

Well Failed

Well Failed

Well Failed

Well Failed

Well Failed

Well Failed

Number of Wells with
Remedial Action
1. Number of Casing Repaired/
Squeeze Cement Remedial Actions
2. Number of Tubing/Packer
Remedial Actions
3. Number of Plugging/Abandonment
Remedial Actions
4. Number of Other Remedial Actions
(Specify)

(Attach additional sheets)

Certification
I certify that the statements I have made on this form and all attachments thereto are true, accurate, and complete. I acknowledge that any
knowingly false or misleading statement may be punishable by fine or imprisonment or both under applicable law.
Signature and Typed or Printed Name and Title of Person Completing Form

EPA Form 7520-3 (Rev. 8-01)

Previous edition is obsolete.

Date

Telephone No.

Instructions and Definitions
(All reporting is cumulative, year to date, and begins with October 1.)

Item D. Fluid Migration Tests: (This year to date)

Section V. Summary of Inspections

Items 1-4: Enter under each well class the number of times wells have
passed or failed a field test/record evaluation for fluid migration (be
specific).

A complete inspection should include an assessment of: the well
head, pressure and flow meters, pipeline connections, and any other
equipment associated with the injection system; an inspection is
complete only when a report has been filed with the regulating
authority.
Item A: Enter under each well class the number of wells that have
been inspected this year to date. These totals track the percentage of
the injection well universe inspected each year. Enter a well only
once each year.
Total Inspections: (This year to date)
Item 1: Enter under each well class the number of inspections to
witness field Mechanical Integrity Tests. (At least 25% of MITs
performed by operators each year should be witnessed.)

Section VII. Summary of Remedial Action
A failure of mechanical integrity (MI) may occur at any time during the
life of an injection well until it is plugged and abandoned in accordance
with a preapproved plan. Failure may be identified duringan inspection,
a field test, an evaluation of well records, or during routine operation of
a well. Remedial actions include additional permit conditions, monitoring
or testing, or one of the actions specified below.
Item A: Enter under each well class the number of wells that have
received remedial actions this year to date. This total tracks the percentage of the injection well universe that have received remedial action each
year. Enter a well only once each year.
Total Remedial Actions: (This year to date)

Item 2: Enter under each well class the number of inspections that
have been in response to a problem reported to the regulating
authority.
Item 3: Enter under each well class the number of inspections of well
constructions or any preoperational activities.
Item 4: Enter under each well class the number of inspections of well
pluggings or pluggings and abandonment.
Item 5: Enter under each well class the number of inspections that
have been routine/periodic.
Section VI. Summary of Mechanical Integrity
A complete MIT is composed of a test for significant leaks in the
casing, tubing or packer and a test for significant fluid migration into
a USDWthrough vertical channels adjacent to the well bore. An MIT
consists of a field test on a well or an evaluation of a well’s monitor­
ing records (i.e., annulus pressure, etc.) or cement records. A t a
minimum, the mechanical integrity of a Class I, II, or III (solution
mining of salt) well should be demonstrated at least once every five
years during the life of the well.
Item A: Enter under each well class the number of wells that have had
a complete MIT this year to date. These totals track the percentage
of the injection well universe tested for MI each year. Enter a well
only once each year.
Item B: Enter under the appropriate well class the number of rule
authorized wells that have passed a complete MIT and the number
that have failed a complete MIT this year to date.

Item 1-4: Enter under each well class the number of times that wells have
received remedial action (be specific).

Paperwork Reduction Act
The public reporting and record keeping burden for this collection of
information is estimated to average 5 hours per response. Burden
means the total time, effort,or financial resource expended by persons
to generate, maintain, retain, or discloseor provide information to or
for a Federal Agency. This includes the time needed to review
instructions; develop, acquire, install, and utilize technology and
systems for the purposes of collecting, validating, and verifying
information, processing and maintaining information, and disclosing
and providing information; adjust the existing ways to comply with
any previously applicable instructions and requirements; train
personnel to be able to respond to the collection of information; sear­
ch data sources; complete and review the collection of information;
and, transmit or otherwise disclose the information. An agency may
not conduct or sponsor, and a person is not required to respond to,
a collection of information unless it displays a currently valid OMB
control number. Send comments on the Agency’s need for this
information, the accuracy of the provided burden estimates, and any
suggested methods for minimizing respondent burden, including the
use of automated collection techniques to Director, Collection
Strategies Division, U.S. Environmental Protection Agency (2822),
1200 Pennsylvania Ave., NW., Washington, DC 20460. Include the
OMB control number in any correspondence. Do not send the
completed forms to this address.

Item C: Significant Leak Tests: (This year to date)
Item 1-4: Enter under each well class the number of times wells have
passed or failed a field test/record evaluation for significant leaks (be
specific).

EPA Form 7520-3 Reverse