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UNDERGROUND INJECTION CONTROL (UIC)PERMIT APPLICATION
PACKAGE
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Office of Oil and Gas601 57th Street, SE
Charleston, WV 25304Phone: (304) 926-0450
“Promoting a healthy environment”
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(4/25)
Page 2 of 2 Promoting a healthy environment
CHECKLIST FOR FILING A UIC PERMIT APPLICATION
Please utilize this checklist to ensure you have prepared,
completed, and enclosed all required documentation and payment to
ensure a timely review of your submittal.
Operator
Existing UIC Permit ID Number
UIC Well API Number
Please check the fees and payment included.
Please check the items completed and enclosed.
_____ Checklist
_____ UIC-1
_____ Section 1 – Facility Information
_____ Section 2 – Operator Information
_____ Section 3 – Application Information
_____ Section 4 – Applicant/Activity Request and Type
_____ Section 5 – Brief description of the Nature of the
Business
_____ CERTIFICATION
_____ Section 6 – Construction
___Appendix A Injection Well Form
___Appendix B Storage Tank Inventory
_____ Section 7 – Area of Review
___Appendix C Wells Within the Area of Review
Office of Oil and Gas Office Use Only
Permit Reviewer
Date Received
Administratively Complete Date
Approved Date
Permit Issued
Fees Payment Type
UIC Permit Fee: $ Check
Groundwater Protection Plan (GPP) Fee: $50.00
ElectronicOther
NYTIS Exploration Company
2D03902262003 47-039-02262
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UIC-1(4/25)
Promoting a healthy environment.Page 2 of 3
Section 3. Applicant InformationOwnership Status: PRIVATE PUBLIC
FEDERAL STATE
OTHER (explain):
SIC code: 1311 (2D, 2H, 2R) 1479 (3S) OTHER (explain):
Section 4. Applicant / Activity Request and Type:A. Apply for a
new UIC Permit: 2D 2H 2R 3SB. Reissue existing UIC Permit: 2D 2H 2R
3SC. Modify existing UIC Permit: 2D 2H 2R 3S
(Submit only documentation pertaining to the modification
request)2D COMMERCIAL FACILITY: YES NO
Section 5. Briefly describe the nature of business and the
activities to be conducted:
Diversified Production LLC is an oil and gas operating facility
that produces natural gas and coalbed methane. The H. F. Lilly 1
well has been a UIC well for the injection of Class II fluids
since1995.Produced fluids are gravity fed to one of four stock
tanks located at the Diversified Production LLCyard on Koala Lane
or hauled in by truck to one truck unloading bay. From there, water
is gravityfed to a pump that discharges into the disposal well API
47-039-02262.
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INJECTION WELL
x-----x
0 � 4' x 4' x 6' CHAIN LINK FENCE
x-----x
DIVERSFIED PRODUCTION LLC
TYPICAL REMOVABLE FENCING
SURROUNDING INJECTION WELLS
DR CONSUL TING SERVICES 262 Ashbrook& Hill, Ashland KY
Phone: 606 922 0363
THE WELL IS NOT LOCATED NEAR THE INJECTION PLANT OR TANK
FACILITY
