7520-2a Compliance Evaluation

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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 II: Compliance Evaluation
(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

HC

2D

2R

2H

III

IV

V

Number of Unauthorized
Injection Violations

2. Number of Mechanical Integrity Violations

Summary
of

ER

Number of Wells with Violations
1.

V.

I

SWD

Total
Violations

B

3. Number of Operation and
Maintenance Violations
4. Number of Plugging
and Abandonment Violations

Violations

5. Number of Monitoring and
Reporting Violations
6. Number of Other Violations
(Specify)
Total
Wells

A

Number of Wells with
Enforcement Actions
1. Number of Notices of Violation
2. Number of Consent Agreements

VI.

3. Number of Administrative Orders

Summary
of
Enforcement

Total
Enforcement

4. Number of Civil Referrals
B

Actions

5. Number of Criminal Referrals
6. Number of Well Shut-ins
7. Number of Pipeline Severances
8.

VII.
Summary
of
Compliance

Number of Other Enforcement Actions
(Specify)
A. This Quarter

Number of Wells
Returned to Compliance

B. This Year

VIII.
Number of Cases of Alleged Contamination of a USDW
Contamination
IX.
MIT Resolved

Percent of MIT Violations Resolved in 90 Days

X. Remarks/Ad Hoc Report (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 7520-2A (1-88)

Replaces EPA Form 7520-2 which is obsolete

Date

Telephone No.

Definitions and Instructions
All reportingis cumulative, year to date, and begins with October 1.

Section VIII. USDW Contaminations

A Class II, III, or V injection well with a violation of a permit or rule
requirement is said to be in noncompliance. A Class I or IV well with
any violation is said to be in significant noncompliance (SNC). Note:
A Class II, III, or V well with certain types of violations may also be
in significant noncompliance. (See Form 7520-2B (Reverse) for
definitions of SNC violations.)

Enter under each well class the number of times a well in noncompli­
ance has allegedly contaminated an underground source of drinking
water (USDW) this year to date.

Section V. Summary of Violations

Section IX. % MIT Violations Resolved in 90 Days
Enter under each well class the percentage of MIT violations
(identified in Section V., under “Mechanical Integrity”) resolved
within 90 days.

(Includes all noncompliance, significant and non-significant)
In order to calculate the percentage:
Note: Also Report Significant Noncompliance Information on Form
7520-2B.
A. Total Wells: Enter under each well class the number of wells with
a violation(s) identified this year to date, whether or not the well has
been returned to compliance. These totals track the percentage of the
injection well universein noncompliance each year. Enter a well only
once each year.
B. Total Violations:
Item 1-6: Enter under each well class the number of times each
violation (be specific) has been identified this year to date.
Section VI. Summary of Enforcement
A. Total Wells: Enter under each well class the number of wells with
violations that have received an enforcement action(s) this year to
date. These totals track the percentage of the injection well universe
that receives an enforcement action each year. Enter a well only once
each year.
B. Total Enforcement Actions:
Item 1-8: Enter under each well class the number of times wells with
violations have received an enforcement action(s) (be specific) this
year to date.
Section VII. Number of Wells Returned to Compliance
A “Well Returned to Compliance” is a well in violation of UIC
program requirements that has had the violation(s) corrected and the
resolution of the violation(s) has been verified by the regulating
authority. Note: An enforcement action alone (e.g., well shut-in) does
not constitute a “return to compliance.”
A. Enter under each well class the number of wells returned to
compliance in the current quarter only.
B. Enter under each well class the number of wells returned to
compliance (as a result of an enforcement action against a violation)
this year to date. These totals track the percentage of the injection
well universe that returned to compliance through an enforcement
action(s) each year. Enter a well only once each year.

1. Add up the total number of MIT violations to date
whether of not they were identified in this reporting
period, e.g., 10.
2. Add up the number of these violations to date that were
resolved in 90 days or less, e.g., 5.
3. Calculatethe percentage of total MIT violations todate
that have been resolved in 90 days or less, e.g., 50%.

Paperwork Reduction Act
The public reportingand record keeping burden for this collection
of information is estimated to average 6 hours per response.
Burden means thetotal 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 informa­
tion, and disclosingand providinginformation; 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
disclosethe 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 informa­
tion, 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 7520-2A Revised