Please type or print all information. Please read instructions on reverse. OMB No. 2040-0042 Ap p roval 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

Significant Noncompliance

O ffic e 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 Perio d (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 SignificantNonCompliance

(SNC) Total Wells A Number of Wells with SNC Violations

Total Violations B 1. Number of Unauthorized Injection SNC Violations 2. Number of Mechanical Integrity SNC Violations 3. Number of Injection Pressure SNC Violations 4. Number of Plugging and Abandonment SNC Violations 5. Number of SNC Violations of Formal Orders 6. Number of Falsification SNC Violations (Specify) Number of Other SNC Violations 7.

VI. Summary
of
Enforcement

Against

SNC Total Wells A Number of Wells with Enforcement Actions Against SNC

Total Enforcement

Actions B 1. Number of Notices of Violation
2. Number of Consent Agreements/Orders
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) Against SNC Violations VII. Summary of Compliance Number of Wells in SNC Returned to Compliance A. This Quarter

B. This Year
VIII. Contamination Number of Cases of Alleged Contamination of a USDW

IX. Well Closure Class IV/Endangering Class V Well Closures Involuntary Well Closure Voluntary Well Closure

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 For m Date Telephone No.

EPA Form 7520-2B (12 -11) Replaces EPA Form 7520 -2 which is ob solete

.

### Instructions and Definitions 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 we lls 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. Note: Significant Noncompliance violations are a subset of the violations reported on EPA Form 7520-2A. Definitions of SNC Violations: SNC violations are violations that endanger or pose a significant potent ial to endanger underground sources of drinking water (USDWs), and violat ions that are not addressed after enforcement actions. For example: 1. The following violati ons for a Class I well:

 Contamination of a USDW;

 Injection of unauthorized fluid(s);

 Injection into unauthorized zones;

 Failure to cease injection after loss of MI detected; Failure to comply with corrective action requirements;

 Failure to operate auto matic shutdown system;

 Failure to operate automatic warning system;

 Unauthorized plugging and abandonment;

 Violation of a Formal Order;

 Knowing submission of false information;

 Violations involving loss of mechanical integrity;

 Violations of maximu m injection pressure;

 Failure to install and/or operat e injection pressure and annulus pressure monitoring systems or othe r monitoring systems, required by permit or rule; and

 Failure to maintain required annulus pressure. Also, any Class I well with a non-SNC violation that is noted three times within twelve months of the first violat ion is considered to be in SNC. List these Class I specific violations unde r Other SNC Violations unless they clearly fall within the categories of violations in the list below. 2. The following violations fo r a Class II, III, or V well:

 Unauthorized Injection – Any unau thorized emplacement of fluids (where formal authorization is required);
 Mechanical Integrity – Well operation without mechanical integrity which causes the movement of fluid outside the authorized zone – if injection of such fluid may have the potential for endangering a USDW;
 Injection Pressure – Well operation at an injection pressure that exceeds the permitted or authorized injection pressure and causes the movement of fluid outside the authorized zone of injection – if such movement may have the po tential for endangering a USDW;
 Plugging and Abandonment – The plugging and abandonment of an injection well in an unauthorized manner. These wells are in SNC only when there is endangerment of USDW and there is an identifiable owner/operator;
 Violation of a Formal Order – Any violation of a formal enforcement action, including an administrative or judicial order, consent agreement, judgment, or equivalent action;
 Falsification – The knowing subm ission or use of any false information in a permit application, periodic report or special request for information about a well; or
 Other SNC Violations. 3. Any violation for a Class IV well. Section V. Total No. of We lls with SNC Violations: Significant Noncompliance violations are a subset of the vi olations reported on EPA From 7520-2A. For each well class, enter the number wells with SNC violations identified in the federal fis cal year to date. Report the well even if the violation has been corrected. Count each well only once. For each well class in subsections 1 through 7, enter the number the number of times each SNC violation has been identified this federal fiscal year to date. Section VI. Total SNC Enforcement Actions: Significant Noncompliance violations are a subset of the viol ations reported on EPA Form 7520-2A. For each well class, enter the number of wells with SNC violations that have received an enforcement action(s) this year to date. Report the well even if the violation has been corrected. Count each well only once. For each well class in subsections 1 through 8, enter the number of times wells with SNC violations have received each type of enforcement action this federal fiscal year to date. Section VII. No. of Wells Returned to Compliance: “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. For each well class in subsection A, enter the number of wells returned to compliance (as a result of an enforcement action against a SNC violation). For each well class in subsection B, enter the number of wells returned to compliance (as a result of an enforcement action against an SNC violation) this federal fiscal year to date. Enter each well only once. Section VIII. USDW Contaminations: For each well class, enter the number of times a well in SNC has al legedly contaminated a USDW this federal fiscal year to date. Section IX. Number of Class IV/V Endangering Class V Well Closures: For Class IV and Class V wells, enter the number of voluntary or involuntary well closures. Voluntary well closure means well clos ed as a direct result of outreach activities. Involuntary well closure means wells cl osed as a result of enforcement actions or permit call-ins. Well closure describes a process to pe rmanently discontinue injection in accordance with the UIC regulations. Paperwork Reduction Act The public reporting and record keeping burden for this collection of information is estimated to average 5.5 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, DC 20460. Include the OMB control number in any correspondence. Do not send the completed forms to this address. EPA Form 7520-2B (11-15) Revised