7520-16 Inventory of Injection Wells

Type or print all information. See reverse for instructions.

OMB No. 2040-0042

INVENTORY OF INJECTION WELLS

1. DATE PREPARED

(Year, Month, Day)

Approval Expires 4/30/07

2. FACILITY ID NUMBER

UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
OFFICE OF GROUND WATER AND DRINKING WATER
(This information is collected under the authority of the Safe Drinking Water Act)

PAPERWORK REDUCTION ACT NOTICE
The public reporting burden for this collection of information is estimated at about 0.5 hour per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection
of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to Chief, Information Policy Branch, 2136, U.S. Environmental Protection Agency, 401 M Street,
SW, Washington, DC 20460, and to the Office of Management and Budget, Paperwork Reduction Project, Washington, DC 20503.

3. TRANSACTION TYPE

(Please mark one of the following)

Deletion

First Time Entry

Entry Change

Replacement

4. FACILITY NAME AND LOCATION
A. NAME (last, first, and middle initial)

C. LATITUDE

DEG

MIN

E. TOWNSHIP/RANGE

SEC

.
B. STREET ADDRESS/ROUTE NUMBER

D. LONGITUDE

DEG

MIN

TOWNSHIP

RANGE

SECT

1/4 SECT

SEC

.
F. CITY/TOWN

G. STATE

H. ZIP CODE

I. NUMERIC
COUNTY CODE

J. INDIAN LAND
(mark "x")

Yes

5. LEGAL CONTACT:
A. TYPE (mark "x")
Owner

B. NAME (last, first, and middle initial)

C. PHONE
(area code
and number)

Operator

D. ORGANIZATION

E. STREET/P.O. BOX

F. CITY/TOWN

G. STATE

I. OWNERSHIP (mark "x")
PRIVATE

PUBLIC

STATE

FEDERAL

SPECIFY OTHER

H. ZIP CODE

6. WELL INFORMATION:
A. CLASS
AND
TYPE

B. NUMBER OF WELLS
COMM

NON-COMM

C. TOTAL
NUMBER
OF WELLS

D. WELL OPERATION STATUS
UC

AC

TA

PA

COMMENTS (Optional):
AN

0

0
0
KEY:

0

DEG = Degree
MIN = Minute
SEC = Second

0
0
0
EPA Form 7520-16 (Rev. 8-01)

SECT = Section
1/4 SECT = Quarter Section

COMM = Commercial
NON-COMM = Non-Commercial
AC = Active
UC = Under Construction
TA = Temporarily Abandoned
PA = Permanently Abandoned and Approved by State
AN = Permanently Abandoned and not Approved by State

No

INSTRUCTIONS AND DEFINITIONS
SECTION 1. DATE PREPARED: Enter date in order of year, month,
and day.

SECTION 4. FACILITY NAME & LOCATION (CONT’D.):
I.

SECTION 2. FACILITY ID NUMBER: In the first two spaces, insert
the appropriate U.S. Postal Service State Code. In the third space, insert
one of the following one letter alphabetic identifiers:
D - DUNS Number,
G - GSA Number, or
S - State Facility Number.
In the remaining spaces, insert the appropriate nine digit DUNS, GSA, or
State Facility Number. For example, A Federal facility (GSA 123456789) located in Virginia would be entered as : VAG123456789.

J.

SECTION 5. LEGAL CONTACT:
A.

SECTION 3. TRANSACTION TYPE: Place an “x” in the applicable

B.

box. See below for further instructions.
Deletion. Fill in the Facility ID Number.
First Time Entry. Fill in all the appropriate information.
Entry Change.
Fill in the Facility ID Number and the information
that has changed.
Replacement.

C.
D.

SECTION 4. FACILITY NAME AND LOCATION:
A.
B.
C.
D.
E.

F.
G.
H.

Name. Fill in the facility’s official or legal name.
Street Address. Self Explanatory.
Latitude. Enter the facility’s latitude (all latitudes assume
North Except for American Samoa).
Longitude. Enter the facility’s longitude (all longitudes assume
West except Guam).
Township/Range. Fill in the complete township and range.
The first 3 spaces are numerical and the fourth is a letter
(N,S,E,W) specifying a compass direction. A township is North
or South of the baseline, and a range is East or West of the
principal meridian (e.g., 132N, 343W).
City/Town. Self Explanatory.
State. Insert the U.S. Postal Service State abbreviation.
Zip Code. Insert the five digit zip code plus any extension.

Numeric County Code. Insert the numeric county code from
the Federal Information Processing Standards Publication (FIPS
Pub 6-1) June 15, 1970, U.S. Department of Commerce,
National Bureau of Standards. For Alaska, use the Census Division
Code developed by the U.S. Census Bureau.
Indian Land. Mark an “x” in the appropriate box (Yes or No)
to indicate if the facility is located on Indian land.

E.
F.
G.
H.
I.

Type. Mark an “x” in the appropriate box to indicate the type
of legal contact (Owner or Operator). For wells operated by lease,
the operator is the legal contact.
Name. Self Explanatory.
Phone. Self Explanatory.
Organization. If the legal contact is an individual, give the
name of the business organization to expedite mail distribution.
Street/P.O. Box. Self Explanatory.
City/Town. Self Explanatory.
State. Insert the U.S. Postal Service State abbreviation.
Zip Code. Insert the five digit zip code plus any extension.
Ownership. Place an “x” in the appropriate box to indicate
ownership status.

SECTION 6. WELL INFORMATION:
A.

B.

C.
D.

Class and Type. Fill in the Class and Type of injection wells
located at the listed facility. Use the most pertinent code
(specified below) to accurately describe each type of injection
well. For example, 2R for a Class II Enhanced Recovery Well, or
3M for a Class III Solution Mining Well, etc.
Number of Commercial and Non-Commercial Wells.
Enter the total number of commercial and non-commercial wells
for each Class/Type, as applicable.
Total Number of Wells. Enter the total number of injection
wells for each specified Class/Type.
Well Operation Status. Enter the number of wells for each
Class/Type under each operation status (see key on other side).

INJECTION WELL CLASS AND TYPE CODES
CLASS I Industrial, Municipal, and Radioactive Waste Disposal Wells

CLASS III (CONT’D.)

used to inject waste below the lowermost Underground Source of Drinking
Water (USDW).

TYPE

TYPE

1I
1M

Non-Hazardous Industrial Disposal Well.
Non-Hazardous Municipal Disposal Well.

1H

Hazardous Waste Disposal Well injecting below the
lowermost USDW.
Radioactive Waste Disposal Well.
Other Class I Wells.

1R
1X

3S
3T
3U
3X

Sulfur Mining Well by Frasch Process.
Geothermal Well.
Uranium Mining Well.
Other Class III Wells.

CLASS IV Wells that inject hazardous waste into/above USDWs.
TYPE

4H
4R

Hazardous Facility Injection Well.
Remediation Well at RCRA or CERCLA site.

CLASS II Oil and Gas Production and Storage Related Injection Wells.
CLASS V Any Underground Injection Well not included in Classes I
TYPE

2A
2D
2H
2R
2X

Annular Disposal Well.
Produced Fluid Disposal Well.
Hydrocarbon Storage Well.
Enhanced Recovery Well.
Other Class II Wells.

CLASS III Special Process Injection Wells.
TYPE

3G
3M

In Situ Gassification Well
Solution Mining Well.

EPA Form 7520-16 (Revised 8-01)

through IV.
TYPE

5A
5B
5C
5D
5E
5F
5G
5H
5I
5J

Industrial Well.
Beneficial Use Well.
Fluid Return Well.
Sewage Treatment Effluent Well.
Cesspools (non-domestic).
Septic Systems.
Experimental Technology Well.
Drainage Well.
Mine Backfill Well.
Waste Discharge Well.

PAPERWORK REDUCTION ACT The public reporting and record keeping burden for this collection of information is

estimated to average 0.5 hours per response. Burden means the total time, effort, or financial resource expended by

persons to generate, maintain, retain, or disclose or 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; search 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, D.C. 20460. Include the

OMB control number in any correspondence. Do not send the completed forms to this address.

EPA Form 7520-16 (Revised 8-01)