OCC/OTC No. _______________ Form 1006BR-A
(Rev 2012)
OKLAHOMA CORPORATION COMMISSION
Oil and Gas Conservation Division
PO Box 52000
Oklahoma City, OK 73152-2000
(TYPE OR PRINT USING BLACK INK)
OPERATOR’S AGREEMENT TO CLOSE FACILITY
OAC 165:10-8-1, 165:10-8-2
KNOW ALL MEN BY THESE PRESENTS:
That ___________________________________________________________________________________, as Operator,
(Name of the Operator, Company or Individual)
Physical Address: _________________________________________ Post Office Box Number: ___________________
(All Operators MUST include a Physical Address)
Phone (____) _______________ City __________________________________ State _______ Zip _________________
Contact Person: ____________________________________ Email Address: ___________________________________
Emergency Information: Contact Person: ___________________________________ Phone (____) _________________
authorized to do business within the State of Oklahoma, proposes to operate a recycling/reclaiming facility, and hereby agrees to close facility in accordance with closure plan at the time and in the manner prescribed by the laws of the State of Oklahoma and the General Rules and Special Orders of the Corporation Commission of the State of Oklahoma.
The operator hereby states that he has met the requirements as stated in OAC 165:10-8-1 and/or 2.
If the Commission determines that the above named operator has neglected, failed, or refused to close the facility at the time and in the manner prescribed by the laws of the State of Oklahoma and the General Rules and Special Orders of the Corporation Commission of the State of Oklahoma, the operator will forthwith forfeit or pay to the State, through the Commission, a sum equal to the cost of plugging the well plus any expenses incurred by litigation to enforce this Agreement, the Commission shall cause the facility to be closed.
Dated this _______ day of ___________________, 20_____.
_____________________________________
Print or Type Name of Operator
Federal Employers Identification Number: _____________________________________
Signature of Operator, Partner, or Principal
_________________________________ Office of Operator
Social Security Number: _____________________
PLEASE ATTACH IMPRINT OF OKLAHOMA CORPORATE SEAL. IF A CORPORATION PLEASE ATTACH A COPY OF THE OKLAHOMA SECRETARY OF STATE DOMESTICATION CERTIFICATE.
