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 12/31/18

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)
To

From

October 1, 20

Class and Type of Injection Wells
II
Item
Total
Wells

A

V.
Summary
of

Total
Inspections

B

Inspections

Total
Wells

A
B

For
Significant

of

C

Leak

Mechanical
Integrity
(MI)

For
Fluid

D

Migration

Total
Wells

A

VII.
Summary
of
Remedial
Action

ER

HC

2D

2R

2H

III

IV

V

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

VI.
Summary

I

SWD

Total
Remedial

B

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

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. 12-31-15)

Previous edition is obsolete.

Date

Telephone No.

Instructions and Definitions
All reporting is cumulative over the fiscal year, and includes
activities from October 1 – September 30. All fields should
contain a value. Do not leave blank fields. Enter 0 if there are no
wells affected or no activities that occurred pertaining to the
information requested. Enter NA if the field or section is not
applicable to the submitter (e.g., the well type is not overseen by
the submitter). Enter U if the information is unknown or not
captured; fields designated as U require explanation.
Section V. Summary of Inspections
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
primacy agency.
Item A: For each well class, enter the number of wells that have
been inspected as of the end of the reporting period. Enter each
well only once.

Item C: Significant Leak Tests: (this federal fiscal year to date)
Items 1-4: For each well class, enter the number of times wells
have passed or failed a field test/record evaluation for significant
leaks.
Item D: Fluid Migration Tests (this federal fiscal year to date):
Items 1-4: For each well class, enter the number of times wells
have passed or failed a field test/record evaluation for fluid
migration.
Section VII. Summary of Remedial Action
A failure of mechanical integrity (MI) may occur at any time
during the life of an injection well. Failure may be identified
during an 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.

Total Inspections (this federal fiscal year to date):

Item A: For each well class, enter the number of wells that have
received remedial actions this federal fiscal year to date. Enter
each well only once.

Item 1: For each well class, enter the number of inspections to
witness field Mechanical Integrity Tests. (At least 25% of MITs
performed by operators each year should be witnessed.)

Total Remedial Actions: (this federal fiscal year to date):

Item 2: For each well class, enter the number of inspections that
have been in response to a problem reported to the regulating
authority.
Item 3: For each well class, enter the number of inspections of
well constructions or any preoperational activities.
Item 4: For each well class, enter the number of inspections of
plugging and abandonment.
Item 5: For each well class, enter 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 USDW through vertical channels adjacent to the well bore.
An MIT consists of a field test on a well or an evaluation of a
well’s monitoring records (i.e., annulus pressure, etc.) or cement
records. At 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: For each well class, enter the total number of wells (i.e.,
permitted and rule authorized) that have had a complete MIT this
federal fiscal year to date. Enter each well only once.
Item B: For each well class, enter the number of rule authorized
wells that have passed a complete MIT and the number that have
failed a complete MIT this federal fiscal year to date.

EPA Form 7520-3 (12-31-15) Revised

Item 1-4: For each well class, enter the number of times that wells
have received remedial action.

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