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The form confirms the permittee understands injection operation conditions, required monitoring and sampling at specified times, routine UIC reporting obligations, the 5-day notification requirement under Part 2, and annual fee and renewal application deadlines. Includes submission due date, facility details, permit number, certification, and signature fields, plus NDEP authorization to inject/discharge details.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/unev87041-uic-permit-acknowledgment-form-u220/245562/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/unev87041-uic-permit-acknowledgment-form-u220/245562.png","ImageObject",442,249,{"name":88,"@type":89},"River Wang","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-23","2026-09-12",true,{"@type":98,"interactionType":99,"userInteractionCount":15},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What is the purpose of UIC Permit Acknowledgment Form U220 for UNEV87041?","Question",{"text":108,"@type":109},"The form must be completed, signed, and returned after issuance of a new, modified, or renewed UIC permit. It ensures permittees read and understand the responsibilities and conditions in the permit.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What key responsibilities does the permittee acknowledge by signing?",{"text":113,"@type":109},"The permit contains specific operating conditions for the injection well(s), monitoring and sampling requirements, routine UIC reporting obligations, and a 5-day NDEP notification requirement under Part 2. It also covers annual fee timing and renewal application requirements.",{"name":115,"@type":106,"acceptedAnswer":116},"How are modification and reporting actions expected to be handled under the permit conditions?",{"text":117,"@type":109},"The included conditions specify that notifications and submissions must occur within defined time frames for different activities, and that required reports and sundry notices must be submitted to the appropriate agencies.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},245562,1789229420,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":15,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":135,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":125,"read_time":45},1099514067438,"https://ap-avatar.wpscdn.com/avatar/100002539ee87300030?x-image-process=image/resize,m_fixed,w_180,h_180&k=1780474512215547542","Nevada Division of Environmental Protection Bureau of Water Pollution Control Underground Injection Control Program  \n901 S. Stewart St Ste 4001  \nCarson City Nevada 89701  \nPh: 775-687-9418 Fx: 775-687-4684  \nUIC Permit Acknowledgment Form U220  \nThis form shall be completed, signed and returned upon issuance of a new, modified or renewed UIC permit. This form is used to ensure that all permittees have read and understand their responsibilities under the requirements and conditions of the permit.  \nPlease ensure that this form is returned by the due date below at the address above, Attn: Permits Branch-UIC Permit Writer. Questions should be directed to the UIC Program at (775) 687-9428 or (775) 848-8118.  \nDate Form Due (postmarked and emailed):  June 5, 2023   \nUIC Permit Number: UNEV87041  Date form submitted to BWPC Permits Branch:    \nFacility Name:  San Emidio / North Valley Geothermal Project   \nBy signing below, you are acknowledging you understand the following:  \n The permit contains specific conditions that the injection well(s) must be operated in accordance with.  \n Monitoring and sampling requirements are contained in the permit, and are required to be done at specific times.  \n Routine UIC reports are required, and must be submitted whether injecting or not.  \n The permit contains a 5-day NDEP Notification Requirement under Part 2.  \n Annual fees are due for this permit July 1 of each year following the original issue date, until the permit is officially cancelled.  \n A renewal application and fee are due 180 days prior to the expiration date on the permit.  \nI certify under penalty of law that all the information submitted on this form is accurate to the best of my knowledge.  \nPrint Name:  Title:   \nSignature:  Date:   \nNDEP Use Only  \nReviewed by:    \nDate:   Entered in database    \nSTATE OF NEVADA  \nDIVISION OF ENVIRONMENTAL PROTECTION  \nAUTHORIZATION TO INJECT/DISCHARGE  \nIn compliance with the provisions of the Nevada Revised Statutes (NRS 445A) and the Nevada Underground Injection Control and Water Pollution Control Regulations (under NAC 445A), the following Permittee is authorized to inject and discharge from a facility described below in accordance with limitations, requirements and other conditions set forth in Parts I and II hereof.  \nPermit Number:  \nFacility Name:  \nFacility Address:  \nPermittee:  \nPermittee Address:  \nLegal Description:  \nUNEV87041  \nSan Emidio / North Valley Geothermal Project Southeast corner of San Emidio Desert  \nORNI 36, LLC  \n6140 Pluma.s S. t  \nReno, Nevada 89511  \nSections 8, 9, 16, 21 T 29N R 23E MDB&M; Washoe County, Nevada  \nNumber of Permitted Wells: Six (6) (subclass SAS) (approved wells listed in table on page 4)  \nOther Permitted Discharges: Water discharge to surface basins (well sites) in accordance with the O&M manual; three surface discharge locations covered by permit NS00094003.  \nReporting Frequency: Semi-annual  \nSpecial Conditions:  \nInjection rate limits (per well and total annual average)  \nModified on: May 28, 2023 by Andrew Kowler  \nModified on: March 7, 2023 by Andrew Kowler  \nModified on: May 27, 2015 by Russ Land  \nThis permit shall become effective: November 19, 2013 .  \nThis permit shall expire at midnight: November 19, 2018-Extension of coverage through the time of permit renewal is contingent upon timely submission of renewal application .  \nTh i s permit originally issued: November 12, 1987.  \nThe UIC renewal application is due 180 days prior to permit expiration.  \nAnnual Fee Due: July 1 of each year  \nRuss Land  \nBureau of Water Pollution Control  \n_________________  \nAndrew L. Kowler, Ph.D. | Environmental Scientist  \nBureau of Water Pollution Control  \nDate  \n5/28/2023   Date Modified  \nTABLEl  \npermittee sha11 notfy the Dv1.s0n when:  \nActivity  \nNew construction of, or conversion  \nof existing well to, injection well  \nInitial injection into well  \nAny modification of injection well  \nTesting of injection well / MIT's  \nConstruction of pro","cbCaiaeelIOHQQ4c","https://ap.wps.com/l/cbCaiaeelIOHQQ4c","pdf",9790458,61,"English","# UIC Permit Acknowledgment Form U220\n## Submission requirements\n## Permittee certification and acknowledgement\n## NDEP use only\n## Authorization to inject/discharge\n## Notification requirement table","[{\"question\":\"What is the purpose of UIC Permit Acknowledgment Form U220 for UNEV87041?\",\"answer\":\"The form must be completed, signed, and returned after issuance of a new, modified, or renewed UIC permit. It ensures permittees read and understand the responsibilities and conditions in the permit.\"},{\"question\":\"What key responsibilities does the permittee acknowledge by signing?\",\"answer\":\"The permit contains specific operating conditions for the injection well(s), monitoring and sampling requirements, routine UIC reporting obligations, and a 5-day NDEP notification requirement under Part 2. It also covers annual fee timing and renewal application requirements.\"},{\"question\":\"How are modification and reporting actions expected to be handled under the permit conditions?\",\"answer\":\"The included conditions specify that notifications and submissions must occur within defined time frames for different activities, and that required reports and sundry notices must be submitted to the appropriate agencies.\"}]","UNEV87041 UIC Permit Acknowledgment Form U220 | PDF"]