WDEQ Water Quality Division Well Plugging and Abandonment Completion Form
All wells must be plugged and abandoned in accordance with Wyoming Water Quality Rules and Regulations Chapter 26, Section 11.
Required fields are noted by a red asterisk.
Please note that Section 11 requires pre-notification of plugging and abandonment activities. Notification of Plugging and Abandonment can be reported using the following webform:
Well Owner Company Name and Contact Information
Include company name, contact, mailing address, contact phone number and email address.
Please complete as much information as possible regarding the well being plugged and abandoned. You may be contacted for additional information if not completed.
UIC Permit Number, Chapter 3 Permit to Construct #, VRP or STP Site Number, SEO Permit Number
DEQ Program for which the well belongs. For example, UIC, STP or VRP. Well Program Area should align with the permit number the well was authorized under.
Solid and Hazardous Waste
Voluntary Remediation Program
Underground Injection Control
Groundwater Pollution Control
Program Contact Person
Please provide the name of the DEQ program Project Manager or Contact Person.
Well Name or ID Number
Other (please describe in Notes section)
Well Latitude (DD.dddddd)
Well Longitude (DD.dddddd)
Well Depth (ft)
Well Static Water Level (ft)
Location of Completion
Fractured or Crevased Bedrock
Well not Cased Below Well Shoe
Production Casing is Severed or Removed
Date of Well Completion
Well Plugging and Abandonment Information
Provide information on the plugging of the well, including date of abandonment work, materials and volumes used, person/company responsible for the P&A oversight.
P&A Supporting Documents
Additional documents to support the plugging and abandonment activities can be uploaded here. If information is not supplied on this e-form, a WDEQ Plugging and Abandonment Form must be uploaded, available at:
Date Well Was Abandoned
Company/Person Who Supervised Work and Contact Inf
Please enter contact information for the responsible party for the plugging and abandonment activity. Name, company, address, phone number and email.
Please enter the plugging material used, the depth of emplacement, and estimated volume. Enter each material used on a different line. For example:
Neat Cement, 0 to 1200 ft bgs, 586 cu ft
Please provide a description of the surface marker, if installed.
Additional P&A Comments
Submitted/Entered by (first and last name)
Send me a copy of my responses
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