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FORMS

Updates

  • All 10-401, 10-403, 10-404, and 10-407 forms with accompanying documentation must be submitted in digital PDF format via email to aogcc.permitting@alaska.gov.
  • AOGCC periodically revises application and reporting forms. Obsolete forms are not accepted.
  • API numbers should be completed as a 14-digit number (i.e.: 50-123-12345-00-00).
  • Certain forms may no longer be required in multiple submittals. Please look in the lower right hand corner to determine the current number of submittals required.
  • 10-404, 10-407 - Submit a well schematic diagram with each 10-407 well completion report and 10-404 Well Sundry Report when the downhole well design is changed.
  • 10-412 - Cells should be formatted as text or date only.
  • Safety Valve System (SVS) Test Report Form. Questions should be directed to Phoebe Brooks.
  • 10-405, 10-406 - EDI file instructions for Production & Injection Data Submittal

Forms

Name Number Revised
Permit to Drill (PDF)
Permit to Drill (Excel)
10-401 03/2021
Surety Bond (PDF) 10-402A 10/2021
Personal Bond (PDF) 10-402B 03/2021
Assignment of CD Form (PDF) N/A 05/2019
Application for Sundry Approvals (PDF)
Application for Sundry Approvals (Excel)
10-403 10/2022
Annular Disposal Application (PDF)
Annular Disposal Application (Excel)
10-403AD 03/2021
Report of Sundry Well Operations (PDF)
Report of Sundry Well Operations (Excel)
10-404 10/2022
Monthly Production Report (PDF)
Monthly Production Report (Excel)
Instructions
10-405 10/2021
Monthly Injection Report (PDF)
Monthly Injection Report (Excel)
Instructions
10-406 10/2021
Well Completion or Recompletion Report and Log (PDF)
Well Completion or Recompletion Report and Log (Excel)
10-407 10/2022
Well Status Report and Gas-Oil Ratio Tests (PDF)
Well Status Report and Gas-Oil Ratio Tests (Excel)
Instructions
10-409 10/2022
Designation of Operator (PDF)
Designation of Operator (Excel)
10-411 07/2009
Reservoir Pressure Report (PDF)
Reservoir Pressure Report (Excel)
Instructions
10-412 10/2022
Report of Injection Project (PDF)
Report of Injection Project (Excel)
10-413 12/2003
Notice of Ownership (PDF)
Notice of Ownership (Excel)
10-417 12/2005
Gas Well Open Flow Potential Tests Report (PDF)
Gas Well Open Flow Potential Tests Report (Excel)
10-421 10/2022
Facility Report of Produced Gas Disposition (PDF)
Gas Disposition Import Form (Excel)
Flaring 1 hour Import Form (Excel)
Instructions
10-422 10/2021
04/2020
04/2020
04/2020
Report of Annular Disposal (PDF)
Report of Annular Disposal (Excel)
10-423 03/2021
Blow-Out Preventer Equipment (BOPE) Test (Excel) 10-424 08/2022
Diverter Test (Excel) 10-425 05/2021
Mechanical Integrity Test (MIT) (Excel) 10-426 01/2017
Annual Reservoir Properties Report (PDF)
Annual Reservoir Properties Report (Excel)
Instructions
10-428 10/2022
Data Request Form (PDF) N/A 01/2016
Test Witness Notification (Web Form) Test Witness 11/2012