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FORMS

Updates

  • The 10-403 form (Application for Sundry Approvals) has been updated. The text in Box 7 has been updated, other changes are to the AOGCC "Use Only" Box and the spacing in Box 10. Operators can start using the updated form immediately and will be required to use the updated form starting July 10, 2023.
  • 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 06/2023
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