| Form 27/27A |  Related  Doc |
| Date Submitted: | 6/28/2021 |
| Date Recv'd: | 6/28/2021 | Assigned by: | Peter Gintautas |
| DocNum: | 402721552 | Facility ID: | 336534 |
| Document Type: | FORM 27 | Project Number: | 18732 |
| Operator Information: |
| Operator: | PDC ENERGY INC |
| Oper. No. | 69175 |
| Address: | 1099 18TH STREET SUITE 1500 DENVER CO 80202 |
| Type Of Facility: | LOCATION |
| Fac. Name | Niles Miller |
| County Name: | WELD |
| Operator contact: | Karen Olson |
| qtrqtr: SESE | section: 20 | township: 3N | range: 66W | meridian: 6 |
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| Remediation Details: |
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| Reason for Report: OTHER |
| Cause of Condition: SITE/FACILITY CLOSURE |
| Potential Receptors: Nearest Well: Domestic - 760 feet W-NW, Occupied Buildings: 736 feet NW |
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| HOW REMEDIATE: | If reportable hydrocarbon impacts, as defined in Rule 912.b., are discovered, a site-specific remediation plan will be developed and submitted via a Supplemental Form 27. If reportable impacts are not encountered, a Supplemental Form 27 closure request will be submitted within 90 days of abandonment and/or decommissioning activities. |
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| INITIAL ACTION: | In accordance with COGCC Rule 911, this form serves as notification for decommissioning and/or abandonment of the production facility or the off-location wellhead and flowline. The ground and sub-surfaces will be visually inspected for hydrocarbon impacts during equipment decommissioning. Field observations and photo documentation will be recorded in a field inspection form for submittal to the COGCC. |
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| RECLAMATION PLAN: | Reclamation will be conducted in accordance with COGCC 1004 Series Rules. |
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| SOURCE REMOVED: | Any hydrocarbon impacted material will be transported off-site to a licensed disposal facility in accordance with Rules 905 and 906. |
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| Correspondence Log: |
| Final Resolution | | Date | Case Closed? | Letter Sent? | CECMC Person | | N/A | N | | Alexander Ahmadian | | | N/A | N | | Taylor Robinson | | | N/A | N | | Peter Gintautas | | | N/A | N | | Alexander Ahmadian | | | N/A | N | | Jason Kosola | | | N/A | N | | Alexander Ahmadian | | | N/A | N | | Alexander Ahmadian | | | N/A | N | | Peter Gintautas | | | N/A | N | | Alexander Ahmadian | |
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| Coordinates: |
| Type | Facility ID | Facility Name/Num | Lat/Long |
| Facility | 336534 | Niles Miller
3N66W20Y | 40.203401/-104.793862 |
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| Remediation | 480367 | Miller 5
| 40.203428/-104.793702 |
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