LOUISIANA DEPARTMENT OF NATURAL RESOURCES OFFICE OF CONSERVATION, ENVIRONMENTAL DIVISION WATER WELL PLUGGING AND ABANDONMENT FORM (DNR-GW-2) WELL OWNER (if different from owner when drilled, note in item 5): Address: Phone Number: ( ) Owner’s Well Number: LOCATION OF WELL: GPS Coordinates: Latitude: ° Longitude: ° ‘ “ ‘ “ Parish: ; Physical Address: Well is Near, Approximately miles from (Crossroads, Railroad, any Landmark, etc.) (Attach a map or sketch or registered permit plat if Rig Supply with form) WELL INFORMATION: Use of Well: Local Well No.: -- Casing material: Diameter of casing: in. Depth of well: ft. Date drilled: by (provide name of Water Well Contractor who installed well or hole): PLUGGING PROCEDURE: Describe in detail how well or hole was plugged (materials used, amount of casing and/or screen removed, or left in hole, etc.): REMARKS: FOR MONITOR/PIEZO/RECOVERY WELLS ONLY SECTION TOWNSHIP RANGE ELEVATION QUAD NO. Water Well Plugging and Abandonment Form (DNR-GW-2) The purpose of the rules, regulations and standards for plugging abandoned water wells and holes, stated herein, is to protect the ground water resources of the state from surface contamination, to prevent movement of water from one aquifer to another, to prevent the entrance of objectionable
LOUISIANA DEPARTMENT OF NATURAL RESOURCES OFFICE OF CONSERVATION, ENVIRONMENTAL DIVISION WATER WELL PLUGGING AND ABANDONMENT FORM (DNR-GW-2) WELL OWNER (if different from owner when drilled, note in item 5): Address: Phone Number: ( ) Owner’s Well Number: LOCATION OF WELL: GPS Coordinates: Latitude: ° ‘ “ Longitude: ° ‘ “ Parish: ; Physical Address: Well is Near, Approximately miles from (Crossroads, Railroad, any Landmark, etc.) (Attach a map or sketch or registered permit plat if Rig Supply with form) WELL INFORMATION: Use of Well: Local Well No.: -- Casing material: Diameter of casing: in. Depth of well: ft. Date drilled: by (provide name of Water Well Contractor who installed well or hole): PLUGGING PROCEDURE: Describe in detail how well or hole was plugged (materials used, amount of casing and/or screen removed, or left in hole, etc.): REMARKS: FOR MONITOR/PIEZO/RECOVERY WELLS ONLY SECTION TOWNSHIP RANGE ELEVATION QUAD NO. Water Well Plugging and Abandonment Form (DNR-GW-2) The purpose of the rules, regulations and standards for plugging abandoned water wells and holes, stated herein, is to protect the ground water resources of the state from surface contamination, to prevent movement of water from one aquifer to another, to prevent the entrance of objectionable
DNR-GW-2.docx