UIC Forms

 

Below is an index of the UIC forms associated with our rules. Before selecting a form, please take a minute to read the following instructions.

Form Integrity - our forms have been created as a protected form and then saved with password protection. While you will be able to enter your data into the text fields provided in the form, you will not be able to alter the format or the context of the form.

To open a form click on either the Adobe (PDF)or Word 97(WD97) link next to the title of the form that you want. Due to the form size and/or form fields some forms may take a minute or two to open. For your convenience, these forms have been designed to allow you to fill the form in on the computer.

To fill in a form using Adobe: enter the appropriate information into the field and tab to the next field. Once all the information is filled in, print the form out, send us a copy, and keep a hard copy for yourself. Adobe Reader will not let you save the document with any of the text you have entered, nor will you be able to e-mail it to us. If you do not wish to fill the form in on the computer, simply print out a copy and either complete it in ink or use a typewriter.

To fill in a form using Word 97: enter the appropriate information into the field and tab to the next field. Once all the information is filled in, print the form out, send us a copy, and keep a hard copy for yourself. These forms can be saved after the information has been entered; however, you will not be able to spell check them since they are form protected. If you do not wish to fill the form in on the computer, simply print out a copy and either complete it in ink or use a typewriter. 

Form #	Form Title (# of pages)	Version
62-528.900(1)	Application to Construct/Operate/Abandon Class I, III, or V Injection Well Systems (14)	WD97	PDF
62-528.900(2)	Certification of Plugging Completion Class I, III, or V Well (1)	WD97	PDF
62-528.900(3)	Construction/Clearance Permit Application for Class V Well (4)	WD97	PDF
62-528.900(4)	Certification of Class V Well Construction Completion (1)	WD97	PDF
62-528.900(5)	Authorization for Class V Well Use (1)	WD97	PDF
62-528.900(6)	Application for Class V Well Plugging and Abandonment Permit (2)	WD97	PDF
62-528.900(7)	General Permit Form for Closed-Loop Air Conditioning Return Flow Class V Injection Well (1)	WD97	PDF
62-528.900(8)	Notification to the Florida Department of Environmental Protection of Class V Well Ownership (3)	WD97	PDF
62-528.900(9)	Inventory Form for Single-Family Closed-Loop Air Conditioning Return Flow and Swimming Pool Drainage Class V Injection Wells (2)	WD97	PDF
62-528.900(10)	Certification of Monitor Well Completion (2)	WD97	PDF