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Form 22, Accident Report

Name

Email

Work Unit

Conor Pesicka

conor.pesicka@state.co.us

Compliance

Please use eForm 22 to submit or send completed PDF directly to Mike Leonard via email at mike.leonard@state.co.us; reporting shall comply with Rule 602.b.

If a spill or release of produced fluids or E&P Waste accompanied the accident/incident, a Form 19 must be also filed in accordance with Rule 906.

Document Title

Revision Date

Form 22 Instructions

February 28, 2021

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