U.S. DEPARTMENT OF THE INTERIORBUREAU OF LAND MANAGEMENT
Wyoming

Wellsite Pad Construction Notice

You must select the field office in which you are conducting your operations.
  Cody Pinedale Rock Springs
  Kemmerer Rawlins Worland
Note: please use a period as a separator instead of a hypen or slash  (e.g. 10.03.08 instead of 10-03-086 or 10/03/08)
BLM Natural Resource Specialist assigned to APD:
Operator: Phone:
Lease Number: Well Name,Number:
Unit,CA: Split Estate: Yes    No
    ¼    ¼ Section: Township North Range West
Date Submitted: Time:
Submitted By: Phone:  Email:
Compliance Coordinator: Phone:  
Construction Contractor: Phone:  
Projected Construction Start Date:
Additional Information?
Leave This Field Blank      
This notice must be submitted prior to disturbance and/or construction and in the time frame specified in the Conditions of Approval of your APD.