| Form 27/27A |  Related  Doc |
| Date Submitted: | 11/9/2022 |
| Date Recv'd: | 11/9/2022 | Assigned by: | Taylor Robinson |
| DocNum: | 403220660 | API number: | 05-123-22408 |
| Document Type: | FORM 27 | Project Number: | 26030 |
| Operator Information: |
| Operator: | PDC ENERGY INC |
| Oper. No. | 69175 |
| Address: | 1099 18TH STREET SUITE 1500 DENVER CO 80202 |
| Type Of Facility: | SPILL OR RELEASE |
| Fac. Name | Dinner 6-5-14 Separator FL Riser |
| County Name: | WELD |
| Operator contact: | Karen Olson |
| qtrqtr: SESE | section: 14 | township: 4N | range: 66W | meridian: 6 |
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| Remediation Details: |
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| Reason for Report: OTHER |
| Cause of Condition: OTHER |
| Potential Receptors: Nearest Well: Irrigation - 940' ESE; Surface Water: Irrigation Ditch - 335' E; Occupied Building: 90 |
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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 the abandonment of the Dinner 6-5-14 wellhead and in-place abandonment of the associated flowline. The ground and sub-surfaces will be visually inspected for hydrocarbon impacts during abandonment activities. 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 | | Taylor Robinson | | | N/A | N | | Nick Cholas | | | N/A | N | | Alexander Ahmadian | | | N/A | N | | Alexander Ahmadian | | | N/A | N | | John Heil | | | N/A | N | | Alexander Ahmadian | | | N/A | N | | Alexander Ahmadian | | | N/A | N | | Alexander Ahmadian | |
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| Coordinates: |
| Type | Facility ID | Facility Name/Num | Lat/Long |
| Facility | 273813 | DINNER
6-5-14 | 40.309536/-104.738062 |
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| Remediation | 484087 | Dinner 6-5-14 Separator FL Riser
| 40.304978/-104.738474 |
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