Facilities located in the Louisiana Coastal Zone as mapped by the Louisiana Department of Natural Resources (LDNR) () must provide verification that the company has either obtained a Coastal Use Permit or is not required to obtain a Coastal Use Permit. 1. Is this facility located in the Louisiana Coastal Zone as mapped by LDNR? Yes No If Yes: 2. Do you have a Coastal Use Permit issued by DNR: Yes No If Yes, Please List your Coastal use Permit Number: 3. Are there any operations at the facility that may impact coastal waters such as any project involving dredge or fill, water control structures, bulkheads, oil and gas facilities, marina or residential development? Yes No If you must contact DNR for a determination (888) 792-0432 or . yes, I have contacted LDNR and this facility is not required to obtain a Coastal Use Permit. If a Coastal Use permit is required, an application was submitted on: SECTION III DISCHARGE INFORMATION – A. Provide the following discharge information: 1. Provide a description of all operations contributing wastewater to the effluent for the outfall including process wastewater, sanitary wastewater, and cooling water and the average flow contributed by each operation. Place an “X” Long Term Maximum here, if Outfall Treatment Outfall Description Average Flow (*) Flow (**) coverage is No. Description in MGD in MGD requested 001 deck drainage 002 produced water well treatment, completion, and workover fluids (includes packer 003 fluids) 004 sanitary waste 005 domestic waste 006 hydrostatic test wastewater
Facilities located in the Louisiana Coastal Zone as mapped by the Louisiana Department of Natural Resources (LDNR) () must provide verification that the company has either obtained a Coastal Use Permit or is not required to obtain a Coastal Use Permit. 1. Is this facility located in the Louisiana Coastal Zone as mapped by LDNR? Yes No If Yes: 2. Do you have a Coastal Use Permit issued by DNR: Yes No If Yes, Please List your Coastal use Permit Number: 3. Are there any operations at the facility that may impact coastal waters such as any project involving dredge or fill, water control structures, bulkheads, oil and gas facilities, marina or residential development? Yes No If yes, you must contact DNR for a determination (888) 792-0432 or . I have contacted LDNR and this facility is not required to obtain a Coastal Use Permit. If a Coastal Use permit is required, an application was submitted on: SECTION III – DISCHARGE INFORMATION A. Provide the following discharge information: 1. Provide a description of all operations contributing wastewater to the effluent for the outfall including process wastewater, sanitary wastewater, and cooling water and the average flow contributed by each operation. Place an “X” here, if coverage is requested Outfall No. Outfall Description Treatment Description Long Term Average Flow (*) in MGD Maximum Flow (**) in MGD 001 deck drainage 002 produced water 003 well treatment, completion, and workover fluids (includes packer fluids) 004 sanitary waste 005 domestic waste 006 hydrostatic test wastewater
O&G-IND%20Application%2010-19-11.docx