Skip to content
Back to Top

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. See Industry Guidance Bulletins 20-001 and 20-002.
  • 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 03/2021
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 03/2020

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 03/2020

Monthly Production Report (PDF)

Monthly Production Report (Excel)

Instructions

10-405 04/2020

Monthly Injection Report (PDF)

Monthly Injection Report (Excel)

Instructions

10-406 04/2020

Well Completion or Recompletion Report and Log (PDF)

Well Completion or Recompletion Report and Log (Excel)

10-407 03/2020

Well Status Report and Gas-Oil Ratio Tests (PDF)

Well Status Report and Gas-Oil Ratio Tests (Excel)

10-409 12/2003

Designation of Operator (PDF)

Designation of Operator (Excel)

10-411 07/2009

Reservoir Pressure Report (PDF)

Reservoir Pressure Report (Excel)

10-412 04/2009

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 07/2009

Facility Report of Produced Gas Disposition (PDF)

Gas Disposition Import Form (Excel)

Flaring 1 hour Import Form (Excel)

Instructions

10-422 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 05/2021
Diverter Test (Excel) 10-425 05/2021
Mechanical Integrity Test (MIT) (Excel) 10-426 01/2017

Application for Certification of Gas Storage Capacity (PDF)

Application for Certification of Gas Storage Capacity (Excel)

10-427 10/2012
Annual Reservoir Properties Report (Excel) 10-428 05/2017
Data Request Form (PDF) N/A 01/2016
Test Witness Notification (Web Form) Test Witness 11/2012