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Get Pdf - Florida Department Of Environmental Protection - Floridadep

Dg., 2600 Blair Stone Road, Tallahassee, Florida 32399-2400 (Filled in by DEP) NOTIFICATION TO FDEP OF CLASS V WELL OWNERSHIP PART I General: Owner's Name Owner's Signature Owner's Address City County Legal Contact (may be same as owner) Legal Contact's Address Zip Telephone Number City County Zip City County Zip Name of Facility Address of Facility Latitude/Longitude of Township, Range, Section PART II Type of Injection Well: (Indicate numbe.

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