BLM Wyoming

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

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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 Casper

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?

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."