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

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Pinedale Field Office Notice of Undesirable Event

This Notice is to be used to meet only the initial notification requirements for an undesirable event.
It DOES NOT replace the NTL-3A Report of Undesirable Events or Right-of-Way Incident Report.

Pinedale
 

Note: please use a period or hyphen as a separator instead of a slash  (e.g. 10.03.08 or 10-03-08 instead of 10/03/08)
Lease or Right-of-Way Number:
Well or Facility Name & Number:  
Operator:
Quarter Sections:    ¼    ¼        Section:         Township         Range

Type of Event : Date & Time of Event:
Cause & Extent of the Event:

Volume of Discharged Material:

          Oil:          Gas:           Water:           Other:

If a fluid release occurred, was the release fully contained by secondary containment?    Yes    No
If a fluid release occurred, did any of the fluid leave the area of the existing road, well pad surface or pipeline ROW?    Yes    No

Submitted By:      Phone Number:      Email:
Company Contact:
Company Contact Phone Number:
Additional Information?

Leave This Field Blank      
This Notice is to be used to meet only the initial notification requirements for an undesirable event.
It DOES NOT replace the NTL-3A Report of Undesirable Events or Right-of-Way Incident Report.
Please contact BLM_WY_WebTeam@blm.gov if you receive an error message after clicking "Submit."