Please type or print all information. Please read instructions on reverse. OMB No. 2040-0042 Approval Expires 11/30/2014

United States Environmental Protection Agency 

Washington, DC 20460 

(This information is solicited under the 

authority of the Safe Drinking Water Act) 

UIC Federal Reporting System 

Part II: Compliance Evaluation 

Office of Ground 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EPA Form 7520-2A (12-11) Replaces EPA Form 7520-2 which is obsolete 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 designated 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 noncompliance. 

(See Form 7520-2B (reverse) for definitions of SNC violations.)

Section V. Summary of Violations

(Includes all noncompliance; significant and non-significant)

A. Total Wells: For each well class, enter the number of wells with 

one or more violations in this federal 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: 

Items 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:

Items 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 indicated in the row, in this federal fiscal year to 

date. (Count each draft and final Administrative Order.)

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 returned 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 quarter 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 noncompliance 

has allegedly contaminated an underground source of 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 Integrity violations 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 

included 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: 

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

• Number of these violations resolved within 90 days as of 3/31 = 2

• Percentage of MIT violation resolved within 90 days = 25%

Example for End of Year reporting: 

• Number of MIT violations that occurred from 7/1 – 6/30 = 10

o 8 from midyear plus 2 additional (4/1 to 6/30) 

• Number of these violations resolved within 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 provide 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 information; search data sources; complete 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 

control number. Send comments 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 

Strategies Division, U.S. Environmental Protection Agency (2822), 

1200 Pennsylvania Ave., NW., Washington, D.C. 20460. Include the 

OMB control number in any correspondence. Do not send the 

completed forms to this address. 

EPA Form 7520-2A (11-15) Revised