S - Waste Isolation Pilot Plant

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S - Waste Isolation Pilot Plant

Title 40 CFR Part 191

Compliance Certification

Application

for the

Waste Isolation Pilot Plant

DEL Attachment 2


U.S. Bureau of Land Management Forms


c

1. TYPC OI W0.K

BUREAUOFLANDMANAGEMENT

APPLICATION FOR PERMIT TO DRILL OR DEEPEN

DRILL 0 DEEPEN 0

I I I

6. D UDuII. ALLDIN 0. ~1.c

7. uau As-.m "An.


. .

.- . IMSTRUCTIOWS

. . . . . - ._ . -. -. . - ._ .

-

CENERAL: TMa fom is desigmdfa -pmpm.ls b- ccr(.in .ell ogrr

tbna, u bdieaed. a all types of lamb 6 kuca h- ' te .etion 4 &be? a

Puled or a Stae acemcy. a bot4 pnt8suat to .ppLiuble Fedrnl ad/- State hwa .nd

rrgll.Licmr Any nerr*urg aPed.l ie*ctioms concemiog tke use of thi. form d the

mtmber of copies to he anbdnd, putidaly wifh regmd to 1 6 .m, or reeicmal

drea an4 ymoticn. either are shown helm or rill be issd by, or =my lw &bed

hau, Ihe local PNknl d o r SUte office.

ITEM 1 : If the proposal it to rrddll to the b.mc mser.oir st a diff-t subsurface loce

tim or to a new mmoir. use tbb fmm with nppmpsime aotr(i- Consult .ppliclblc

State ot Fedenl re@atioms mncnning sllboequent work propods or reports on the well.

ITEM 4: I[ thm uc so applicable Stlte rupi-ents, locations 00 F-1 or Indim

1-d should be dessibed in acconlmrce with Fedenl -ests.

w Fedenl office for speciGc insMctious.

Cousnlt local State

ITEM (4: Needed d y when location of well c8nnot readily be follnd by mad from the

Imd or 1ea.e description A plat. or plats, sep.rate or on this m e side. sh0-g the

mads to, .nd the sumeyed loc8tiom of. the well. and any other requirdidormation. shoold

h fmnisbed ahen mmired by Federal or St8te agency office..

ITEMS IS ANO 18: lf well )s to be. 01 h8s been directiopllly drilled. eve distances for

subsdace location of hole in pny psat or objective pmcktnion zone.

ITEM e. Consalt applicable F-1 Or'Stnte recdations. or app-eate

crming approval of the pmpooal before opmtions are stuted

cfficials, con-

-

NOTICE

Tbe Privacy Act of 1974 nnd the rrgrrlatioo in 43 CFR 2.4Nd) provide that you be furnished

the following idrnr.tiom ill Urnnectiou mth iUfOIm8tiOn by this npplicatioo.

AUTHORITY: 30 U.SC 181 et t4.. 25 U:Sc. 3%: 43 CFP. Ppt 3160.

PRlNClPAL m E 'Ilc inforpatio. is 10 k Iwd to pmcea nd cvrluu y ~ sppliurioa r for permit

10 drill Or deep I8 oil 01 8s Well.

ROUTINE USES: (1) The dysis of the applic.nt's -ml to discover and extract

the Federal or Indiau Rsows encountered. (2) The mi- of pocedures aud equip

-t and the projected impact on the land involved (3) Ibe evaluation of the effects of

pmposed oper8tion on mrfacc md subsurface amter Md 0th- .enri.olmental impacts.

(4)(5) Momstion from the record .nd/or the record Will be umofnrcd to 8ppropriote

Federal. %ate, local or foreign a-cies. ahen relevarat to civil, enminal or re@utory

investigations or pmse=3xtiour, as well as routine regul.torg responsibility.

EFFECT OF NOT PROVIDING INFORMATION Filisg of tkir appliulion aid disclossre of the

imfomatios ir ma.d.ior)r oaly if the opentor elmu 10 imili.tc drillimgopenliom 00 am oil amd gS lux.

BURDEN HOURS STATEMENT

Public reporting burden forthh form isenimued to amage Mninutcspermporsc. includingthe time for

reviewing ijsnxtiots, gmhing md dtainhg data. and compleung and rmxiag thc form. hrect

commcnurryrdithe burdrnotimucormyother~ofthirformtoU.S. Ikpmmentofthclnterior.

Bureau of tnd Managemat. (Nlmutc) Buruu c*Maa Offkr. (WO-771). I849 C SvCn. N.W..

Washington. D.C. 20240. ad tk Mi of Mmymcnt and Budget, Paperwork Redunion Rojen

(10044136). Wahingtoa D.C. Mso3.

me Paperaork Reduction Act of 1980 (44 U.S.C. 3501 et scq) -re% us to inform YOU

(bal:

This informmtion is being collected to allow evaluation of the technical. safrty, md cn-

d-ental facton involved With drilling for oil nud/or gas on Feden1 nnd Indian oil

md gas leases.

Tbir id-atioa rill be used to aalyze .nd approve applications.

Ruposrc Y) Ibis rrqmut h maadalmry Omly if lbc Openlor clccts to imiIi.1~ drilling operalions 01 1. oil

1.d gas luu.

*US. CPOs 1991-573-016/26066


Form 31604

(July 1992) SUBMIT IN DZRUUTE.

UNITED STATES

DEPARTMENT OF THE INTERIOR

BUREAUOF LANDMANAGEMENT

t?**.ulh*il$i

.I,YC,I.I". 111

mve". .)I!.,

r- WELL COMPLETION OR RECOMPLETION REPORT AND LOG*

1. TYPE OF WELL

X L 0 ?:x8 0 0". 0 0lh.l

I I I I I

I I

*(See In-ciianr and Spaen Icr Additional Data on Rwm Side)

FORM APPROVED

OMB NO 10014137

Lprer: Februan 3, I995

:. I.*..Sr. "..,*)l.rI"" 1°C. .'"'.L "0

rille 1s U.S.C. Section 1001. maker it a cnme for any person knowingly and 0rillIulIy to make 10 any department or agency of the

United Sriler any false. fic:itiouL 01 fraudulent OtPxement5 or repre~enfstlon~ as to any matter wUm it5 junsdiction.


37. SUMMARY OF POROUS ZONES: (Show all irnporlanl zones of porosily end conlents thereof; cored inlerval~; and .I!

drill-stern. testa. including depth inletval lerled. cushion used, lime lool open. flowing and shul-in pressures.

recoverier):

BOTTDM

~~

DESCRIPTION. CONTENTS, ETC.

38.

NAME

GEOLOGIC MARKERS .’

MEAS. DEPTH

T

P

TRUE

VERT. DEPTH


TYPE OF SUBMISSION

UNITED STAT=

DEPARTMENT OF THE INTERIOR

BUREAU OF LAND MANAGEMENT

SUNDRY NOTICES AND REPORTS ON WELLS

Do not use this form for proposals to drill or to deepen or reentry to a different resewoir.

Use “APPLICATION FOR PERMIT-” for such proposals

SUBMIT IN TRIPLICATE

- “DC Of Wcll 1

TYPE OF ACTION

I

FORM APPROVED

Budp &mu No IUY413S

7. ir ulvi or CA. Ag-t ~er~gnum


This form is designed for submiuing proposals to prform Cmain well o p-

arions. and rcports of such operations when completed. as indicated. on

?ral and Indian lands pursuant to applicable Federal law and regula-

3, and, if approved or accepted by any State, on all lands in sucb State.

pursuant to applicable State law and regulations. Any necessay special in-

GENERAL INSTRUCTIONS

SPEC1 FIC INSTRUCTIONS

sm~ctlons cowmng the we of thls form and the number of copes to k

sub&. pa~~cularly with regard to local Ma, Or regiod

and ptacttces, uther arc shown klow or will be issued by, or may 1

tamed from. the local Federal and/or State office.

frem &If there arc no applicable State requirements. locations on Federal zones, or other zones with present significant fluid contents not scaled off

or Indian land should be described in accordance with Federal miranem. I bv ccmenl or Mhcnviw. d& (too and &om) and method of ~iacmmt

Consult local State or Federal offtce for specific instructions.

&cement plugs: mud or oker %enat placed below. benvcm Bod above

plugs: amount, size. mcmod of parting of any casing. lina or tubing pulled

hem 13--Proposals to abandon a well and subsequent report5 of abandon- and the dcpth to top of any left in the hole; method of dosing top of well;

ment should include such spccial information as is rquircd by Id Feder- and date well site conditioned for final inqxeion looking to approval of

al ador State officcs. In &tion, such pmposais and rcpom sbould include the abandonment.

rcam~~ for the abandonment; data on any former or present productive

, .

NOTICE

The Privacy AR of 1974 and the regulation in 43 CFR 2.48(d) provide chat you k furnished the

following information in connection with information required by this application.

AIJWIORITY: 30 U.S.C. 181 d. seq., 351 et. sq., 25 U.S.C. ct. sq.; 43 CFR 3160.

PRINCIPAL PURPOSE - The information is to k used to evaluate. when appropriate. appmve

applications. and rcpon completion of secondary well opcracions, on a Federal or Indian Icaw.

ROUTINE USES:

(1) Evaluate the equipment and praedure5 used during the proposed or completed subsequent

well oprations.

(2) Request and gnnt approval to perform those actions covered by 43 CFR 3162.3-Z(2).

(3) Analyze fururc applications to drill or modify opcnoonS in light of data obtaid and nurhais

Used.

(4)(5) Infodon from the record andor the record will k transferred to appropriate Federal,

State, local or foreign agencies. when relevant to civil, criminal or rcgulamy invcstipiaons

or prosecutions.

EFFECT OF NOT PROVIDING INFORMATION - Filing of this notie and repon and disclosure

of the information is mandatory o m an oil or gas well is drilled.

The Paperwork Reduction Act of 1980 (44 U.S.C. 3501, ct. seq.) requires us to inform yw that:

This information is king collected in order to cvaluav proposed andlor completed subsequent well

operations on Federal or Indian oil and gas leaxs.

This information will be used to rcpon subsequent operations once worl; is cornpletd and when

requested. IO obmn approval for subsequent opcruions not previously authorized.

Rapon% to this quest k maKktory for the @tic rypa of mivma spaiW in 43 CFR Pan 3160.

BURDEN HOURS STATEMENT

Publicreportingburdrnforthirformircnimattedtoa~~25minulcrpermponw,iosludingthetimcfor

reviewing imtrunionr. gathering and maintaining data and completing and reviewing the form. Dirm

commcnlsregudingthe burden~timateoranyotherupnoft~formto US. Lkpvtmcntofthe Interior.

Bureau of Land Mpnyment. (Altcnute) Bureau Clearance OK=, (WO-771). 18 and C Succlr. N.W.,

Wzhington. D.C. 20240. and the Ofkc of Management and Budget. Paperwork Redunion Project

(ILW4-0135). Washingion. D.C. 10503.


Form 3310-1

(USY 1984)

c

UNITED STATES

DEPARTMENT OF THE INTERIOR

BUREAUOFLANDMANAGEMENT

PROSPECTING APPLICATION AND PI

2. Give legel description of land requested (See Gcnernl

Insrrurtron /m ~?ss~s~~ncc on land description ij nredcdl

Total acre; I Rental Submitted S

!MlT

I 1. What mineral are you applying fox

FORM APPROVED

OMB NO. 1002-0030

Emires: May 31. 1990

3. Legal description of land included in permit

APPLICANT DOES NOT FILL IN rtiis SPACE

Total acres 1 Rental retained S

~~~ ~~

&Are you the sole panY in interest? n Yes No IZee Sperilic lnsrrucrion No. 51

Are you B citizen of the United States? Yes 0 No I b. Are you over the age of majority? u Yes 0 No

7n. Is application made for a-corporation or other legal entity? 0 Yes 0 No fSee Jpeci/ic Insrrurrrons No. 70 and 761

b. Has a statement of qualification been filed? 0 Yes 0 No (I/ “yes.” giue /ile nurnberl

8. Have you enclosed a filing fee

of5 CI Yes

9. Have you enclosed the first year‘s advance rental computed at the rate of

~ ~~

I ‘CERTIFY mat my Interests. direct or indirect, m leases, pemxts. and spp~ic~txons therefor. do not exceed the maxmum permitted by law

or regulation, and that the statements made herein are tme, complete. and correct to the best of my knowledge and bekcf and are madem

good faith.

(Signature of Applicant) (Signature of Applicant)

(Date) (Attorney-in-fact)

Title 18 U.S.C. Section 1001. makes it a crime for any person knowingly and willfully to make to any department or agency of the

Uniied States eny false, fiCtitimS or fraudulent Statements 01 representations as to any matter within its jurisdiction.

A permit for the lands in Item 3. above is hereb issued under the

0 Mineral Leasing Act, 30 U.S.C. 181 et seq. 6 Acquired Lands

Leasing Act, 30U.S.C. 351 efseq. 43CFR3511 pf seq. andissubject

to all regulations in force and to the terns and conditions set forth on

h

Effecuve date of pernit BY

Thrs permit is issued for a period of-years

DO NOT WRITE BELOW THfS LINE

PROSPECTING PERMIT

the reverse side hereof.

This permit, to the extent applicable, is subject to standard or special

stipulations. Stipuktions if any, are attached.

THE UNITED STATES OF AMERICA

(Signing Officer)

(Title)


Sec. 1. Prospecting. Permittee shall diligently prospect the lands by

core drilling or other acceptable methods. Permittee shall notify the

authorized officerin which thepermitlandsaresituaiedofhis plansfor

prospecting prior to commencement of prospect work.

Sec. 2. Operating regulations. (a) Permittee shall comply with all

regulations of the Secretary of the Interior: and, as to the lands

described herein under his jurisdiction, to the regulations and ordersof

the Secretary of Agriculture.

(b) Permittee shall comply with the provisions of the operating

regulations of the Bureau of Land Management (43 CFR 3570) and all

orders issued pursuant thereto. Copies of the operating regulations

may be obtained from the authorized officer.

(c) Permittee shall not prospect lands under administrative juris.

dinion of the Forest Service without prior notice to and consent of that

Service to a pian for prospecting.

(d) Permittee shall allow inspection of the premises and operations

by duly authorized representatives of the Departments of the Interior.

Agriculture. orotheragencyadministering thelandsandshall provide

forthefreeingressoregressofGovernmentofficenandforusersofthe

lands under authority of the United States.

Sec. 3. Multiple use. (a) Valid existing rights acquired prior hereto on

the lands described herein will not be adversely affected hereby.

(bl The granting of this permit will not preclude the issuance of

other permits, leases, or other development of the same lands.

(cl The permitted lands shall be subject, at all times. to any other

lawful uses by the United States. its lessees, permittees. licensees, and

assigns. but such use shall notmateriallyinterferewith thepermittee's

operalions hereunder.

(d) The Government reserves theright tosell or otherwisedisposeof

the surface of the permitted lands under existing law or laws hereafter

enacted. insofar as such disposal will not materially interfere with the

rights of the permittee.

(el The permittee shall afford all facilities for inspection of the

prospecting work on behalf of the Secretary of the Interior or head of

agencyadministering the landsandtomakeareport,on demand, ofall

matters pertaining to the character, progress. and results ofsuch work.

(0 The permittee shall observe such conditions as to the use and

occupancy of the surface of the lands as provided by law, in case any of

said lands shall have been or may be entered or patented with a

reservation of mineral deposits to the United States.

Sec.4. Removolofdeposits. Permitteeshall removefromthelandsonly

such deposits as may be necessary toexpenmental work or toestablish

theexistenceofvaluabledepositswithinthepermitareaandshall keep

a record of all mineral mined.

Sec 5. Rental. Permittee must pay an annual rental of cents per

acre. or fraction thereof. but not less than 620 per year. The annual

rental payment shall be made on or before the anniversary date of the

permit.

Sec. 6. Extensionofpermit. (a) This permitmay besubject toextension

under applicable regulation upon approval of the authorized officer of

the Bureau of Land Management and upon the showing of entitlement

thereto.

(b) Application for extension of this permit. where authorized by

law or regulation, must be filed. in duplicate. in the proper BLM office

within the period beginning 90 days prior to the date of expiration of

this permit. Unless such an application is filed within the tine

specified, this permit will expire without notice to the permittee.

jec. 7. Reward for discouery. Permittee may apply for a preference

right lease if he shall have discovered valuable deposits of minerals

covered by this permit within the permit area and within the period of

this permit as issued. The showing required to be made in the

preference-right lease application is set forth in the Lppropriate

regulation. In addition, the applicant for a sodium, potassium. or

PERMIT CONDITIONS

-

sulphur preferenceright lease must show that the lands applied for art

chiefly valuable. See appropriate regulations. Also see appropnatt

regulation for limitation on acreage holdings.

Sec.8. Equalopportunityclave. This permitissubjecttothepror.=ion.

of Executive Order No. 11246 of Sept. 24.1965, as amended. which seu

forth the nondiscrimination clauses- A copy of this order may be

obtained from the signing officer.

Sec. 9. Assignments. All assignments or transfers of this permit or of

any interest therein. whether by direct assignment. operating agree-

ment sublease. working interest. royalty interest. or otherwise. must be

filed with the Bureau of Land Management for approval in accordance

with the provisionsofthe appropriate regulation and will takeeffect as

ofthefirst day of themonth following approval thereof. or. if transferee

sorequests,asofthefirstdayofthemonth duringwhichsuch approval

is given.

Sec. 10. Relinquishment of permit. Permittee may relinquish chi?

permit, in whole or part, by filing in the proper BLM office a written

relinquishment.in triplicate, whichshall beeffectiveasofthedateit LS

filed. subject to the continued obligation of permittee and his surety to

make payment of all accrued rentals and royalties: and. to provide for

the preservation of any mines or productive works. or permanent

improvements on the pennit land as required by the applicable

regulations and terms of this permit.

Sec. 11. Termination or cancellation. (a1 This permit shall terminate

automatically upon failure of the permittee to pay the rental on or

before the anniversary date thereof, except that if the time for payment

falls upcn any day in which the appropriate land office to receive

paymentisnotopen,paymentreceived on thenext official workingday

shall be deemed to be timely.

(b) Thispermit may becancelledinaccordancewith the regulations

upon failure by permittee toexerciseduediligenceintheproseci"?of

the prospecting work or for violation of any terms and COT IS

hereof. or any of the pertinent regulations.

jec. 12. Protection of surface. natural resources. and improvements.

Thepermitteeagreestotakesuchreasonablestepsas may beneededto

prevent operations on the permitted lands from unnecessarily:

:11 causing orcontributingtosoilerosionordamaging crops.including

forage, and timber growth thereon or on Federal or nan-Federal lands

.n the vicinity; (2) polluting air and water: (3) damaging improve.

nents owned by the United States or other-panies; or (4) desuoyinp.

iamaging or removing fossils. historic or prehistoriciuins. arartifacts:

3nd upon any partial or total relinquishment or the cancellation or

!xpiration of this permit, or at any other time prior thereto when

Fquired and to the extent deemed necessary by the lessor to fill any

iits. ditches and other excavations, remove or cover all debris. and so

:ar as reasanablypossible.restorethesurfaceofthepermitied land and

iccess roads to their former condition. including the removal of

itructures as and if required. The lessor may prescribe the steps to he

aken and restoration to be made with respect to the permitted lands

mdimprovements thereon whetheror not owned by the United States.

jec. 13. AntiQuIties and obiects of historic value. When American

intiquities or other object, of historic or scientific interest includinp

nut not limited to historic or prehistoric ruins. fossils or artifacts are

liscovered in the performances of this permit. the item(s) or condi-

ionW will beleftintactandimmediately broughtto theattention ofthe

:ontracting officer or his authorired representative.

jet. 14. Sodium deposits in oil shale areas. If this application is for

:odium minerals in the oil shale area described in P.L.0. 4522.

ieptember 24. 1968. a prospecting permit will be issued only in those

ireas where it is believed likely that, if sodium deposits are found&ey

"ill OCCUT in discrete beds where development of the sodium dr 's

vouldnotadverselyaffecttheoilshalevalvesofthelands. Anys 3

irospecting permits or preference-right leases that may issue on tnese

Nil shale lands will be restricted to those beds valuable for sodium

which the Secretan of the Interior or his delegate determines to be

workable without removal of significant amounrs of organic matter

Ind without significant damage to oil shale beds.

*U.S. GOVERNMENT PRINTING OFFICE (PW-57r.87'

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