Notification of Well Plugging and Abandonment to WDEQ WQD
Use this form to notify the WDEQ Water Quality Division of well plugging and abandonment activities as required by Chapter 26 Section 11.
Date of Notification to WDEQ
Facility Name and Address
Facility name and location address of the wells being plugged and abandoned.
State Program under which the wells were installed.
Groundwater Pollution Control
Land Quality Division
Solid and Hazardous Waste
State Engineers Office
Storage Tank Program
Underground Injection Control
Voluntary Remediation Program
Permit or Project Number
Permit or Project Number under which the wells were installed.
Regulatory Project Manager or Contact
Contact name of your regulatory program contact person.
Description of P&A Activities
Provide some basic information regarding planned P&A activities.
Date of Planned Abandonment
Date well plugging and abandonment activities are expected to occur.
Name and Contact Information
Name, company name, email address and phone number of the person submitting the plugging and abandonment notification.
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