Farwest Well Drilling Pump Company

Please fill out the following form:
If you want to abandon a well

Fields marked with an * are required

Contact Information:

Comments

Abandon well questions:
Are you required to abandon a well?

	Yes
	No

What application was this well for?



How many well/s are to be abandoned



Do you have a well registration number through ADWR or New Mexico Office of the State Engineer

	Yes
	No
	N/A

If Yes, what is the well registration number?



If No, please give us a description of the well that will be abandoned.



Is there any equipment installed down in the well?

	Yes
	No
	N/A

If Yes, please list the equipment



Are there any environmental issues related to the well?

	Yes
	No
	N/A

If Yes, please list the issues



Will there be any other government agencies involved with the abandonment of this well/s?

	Yes
	No
	N/A

If Yes, please list the agencies



Have you applied for a permit through ADWR (Arizona Department of Water Resources) or (New Mexico Office of the State Engineer) for an abandonment?

	Yes
	No

If you have not applied yet, would you like Farwest to assist you in the permitting process?

	Yes
	No
	N/A