Please type or print all information. Please read instructions on rever se. OMB No. 2040-0042 Approval Expires 11/30/2014 United States Environmental Protection Agenc y Washington, DC 20460

(This information is solicited under the authority of the Safe Drinking Water Act) 

### UIC Federal Reporting System 

## Part II: Compliance Evaluation Offic e of G round Water and Drinking Water I. Name and Address of Reporting Agency United States Environmental Protection Agency

II. Date Prepared (month, day, year) III. State Contact (name, telephone no.) IV. Reporting Period (month, year) From 

## October 1, 20 To

Item Class and Type of Injection Wells

I II

III IV V SWD 2D ER 2R HC 2H

V.

Summary

of

Violations Total Wells A Number of Wells with Violations

Total Violations B 1. Number of Unauthorized Injection Violations

2. Number of Mechanical Integrity Violations

3. Number of Operation and Maintenance Violations

4. Number of Plugging and Abandonment Violations

5. Number of Monitoring and Reporting Violations

(Specify) 6. Number of Other Violations

VI.

Summary

of

Enforcement Total Wells A Number of Wells with Enforcement Actions

Total Enforcement

Actions B 1. Number of Notices of Violation

2. Number of Consent Agreements

3. Number of Administrative Orders

4. Number of Civil Referrals

5. Number of Criminal Referrals

6. Number of Well Shut-ins

7. Number of Pipeline Severances

8. Number of Other Enforcement Actions (Specify) VII. Summary of Compliance Number of Wells Returned to Compliance A. This Quarter

B. This Year

VIII. Contamination Number of Cases of Alleged Contamination of a USDW

IX. MIT Resolved Percent of MIT Violations Resolved in 90 Days
X. Remarks/Ad Hoc Report (Attach additional sheets)

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. Certification

Signature and Typed or Printed Name and Title of Person Completing Form Date Telephone No.

EPA Form 7520-2A (12-11) Replaces EPA Form 7520-2 which is obsolete

## Definitions and Instructions
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 des ignated as U require explanation

. A Class I, II, III, IV, or V injection well with a violation of a permit or rule requirement is said to be in noncompliance. Note: A well with certain types of violations may also be in significant non compliance. (See For m 7520

- 2B (r everse) for definitions of SNC violations.) Section V. Summary of Violations (Includes all noncompliance ; significant and non

- signifi cant)

A. Total Wells: For each well class, e nter the number of wells with
one or more violation s in this fe deral fiscal year to date

. Enter each well only once. Include all wells with violations, even those with violations that have been returned to compliance.

B. Total Violations:

Item s 1- 6: For each well class, enter the number of times each violation type has been identified this federal fiscal year to date. Section VI. Summary of Enforcement

A. Total Wells: For each well class, enter the number of wells with
one or more violations that have been addressed by the specific type of enforcement action in this federal fiscal year to date. Enter each well only once.

B. Total Enforcement Actions:

Item s 1- 8: For each well class, enter the number of times wells with
one or more violations have been addressed by the specific type of enforcement action indica ted in the row , in this federal fiscal year to date. (Count each draft and final A dministrative O rder .) Section VII. Number of Wells Returned to Compliance A “Well Returned to Compliance” is a well that has all underlying violations resolved and compliance has been verified by the primacy program . Note: An enforcement action alone (e.g., well shut

- in) does not constitute a “return to compliance ;” however, plugging and abandonment does constitute a return to compliance.

A. For each well class, enter the number of wells return ed to compliance through the second quarter for midyear reporting and through the fourth quarter for end of the year reporting.

B. For each well class, enter the number of wells returned to compliance through the second qua rter for midyear reporting and through the fourth quarter for end of the end of year reporting.

Section VIII. USDW Contaminations
For each well class, enter the number of times a well in noncom pliance has allegedly contaminated an underground source o f drinking water (USDW) this federal fiscal year to date. Section IX. Percent of MIT Violations Resolved in 90 Days For each well class, enter the percentage of MIT violations resolved within 90 days as of the end of the reporting period.

• Mechanical In tegrity violati ons are as defined in Section V, under “Mechanical Integrity

. ”

• Resolved is defined as returned to compliance (per Section VII).

• MI violations not associated with loss of mechanical integrity (such as reporting) are not counted under this section.

• Violations occurring WITHIN 90 days of September 30 should be includ ed in reporting for the following federal fiscal year. To calculate the percentage:

• Add up the total number of MIT violations that occurred within a one year period prior to 90 days before the end of the fiscal year reporting cycle i.e. , 6/30

. • Add up the number of these violations that were resolved within 90 days as of 3/31 (for midyear reporting ) or as of 9/30 (for end of year reporting).

• Calculate the percentage of total MIT violations that were resolved in 90 days or less. Example for Midyear reporting :

• N umber of violations that occurred from 7/1 – 3/31 = 8

• Numbe r of these violation s resolved within 90 days as of 3/31 = 2

• Percentage of MIT violation resolved with in 90 days = 25% Example for End of Y ear reporting :

• Number of MIT violations that occurred from 7/1 – 6/30 = 10
o 8 from midyear plus 2 additional (4/1 to 6/3 0)

• Number of these violations resolved with in 90 days as of 9/ 30 = 5
o 2 ( from midyear ) + 3 ( from 4/1 to 6/30)

• Percentage of MIT resolved within 90 days by 9/30 = 50%

Paperwork Reduction Act The public reporting and record keeping burden for this collection of information is estimated to average 6 hours per response. Burden means the total time, effort, or financial resource expended by persons to generate, maintain, retain, or disclose or pro vide information to or for a Federal Agency. This includes the time needed to review instructions; develop, acquire, install, and utilize technology and systems for the purposes of collecting, validating, and verifying information, processing and maintaining information, and disclosing and providing information; adjust the existing ways to comply with any previously applicable instructions and requirements; train personnel to be able to respond to the collection of informa tion; sear

ch data sources; comple te and review the collection of information; and, transmit or otherwise disclose the information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB contro l number. Send com ments on the Agency’s need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including the use of automated collection techniques to Director, Collection Stra tegies Division, U.S. Environmental Protection Agency (2822), 1200 Pennsylvania Ave., NW., Washington, D.C. 2046 0. Include the OMB control number in any correspon dence. Do not send the completed forms to this address.

EPA Form 7520

- 2A (11-15 ) Revised