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Click ‘Get Form’ to open the GEOLOGICAL SURVEY SAMPLE No. in the editor.
Begin by filling out the Owner Name and Mailing Address in section A. This information is crucial for identifying the well's owner.
Next, provide the Well Location details including County, Physical Address, and GPS coordinates (Latitude and Longitude) in sections 2, 4, and 5. Accurate location data is essential for compliance.
In section B, enter historical data about the well such as Driller's name, License Number, Date Drilled, Diameter of Hole, and Total Depth of Well if available.
Proceed to section C to input current plugging data. Fill in the Date Well Plugged and select the method of plugging used by clicking on the appropriate button.
Complete section C by providing casing and cementing data relative to the plugging operations. Ensure all required fields are filled accurately.
Finally, validate your information in section D by certifying that all statements are true and correct before submitting your form.

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