Surface Water Discharge Checklist

Surface Water Discharge Checklist

All Teine Employees and Contractors
For pumping water off any Teine lease

**WATER MUST BE RELEASED IN A MANNER THAT DOES NOT CAUSE FLOODING OR EROSION**
Your Name*

First NameLast Name
Date*

MonthDayYear
Date
Time*

:HourMinutesAM/PM Option
Area*

Avon HillChauvinColevilleDodslandHoosierPlatoDrayton Valley
Group*

CompletionsConstructionDrillingOperations
Site Location*
Estimate of water to be pumped of in m3*
Surface Water location (include pictures of area)*

Tank BermSite BermOther
Picture of surface water location*

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Cancelof
** If a sheen is visible, water must not be pumped off and needs to be disposed of**

Alberta

If pH is between 6 and 9 to pump off; less than 6 or greater than 9 must be disposed

Saskatchewan

If pH is between 6 and 8 to pump off; less than 6 or greater than 8 must be disposed
pH level (Please upload a picture of the test strip for proof)(If No please add comment below)*
Test Strip comment
Picture of test strip*

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Cancelof
Is chlorine less than 250mg/l? (Please upload a picture of the test strip for proof)(If No, please add comment below)

YesNo
Picture of test strip*

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Cancelof
** All pump off's will require documented landowner permission**

Readings greater than 250mg/L please contact:

Alberta

Brent Satre - 780-361-7608

OR

Landon Johnson - 306-307-6377

Saskatchewan

Mike Cholin - 306-834-9010
Chloride - Is chloride less than 250mg/l?

YesNo
Land Owner Name*

First NameLast Name
Date*

MonthDayYear
Date
Documented Landowner Permission (e-mail, signature, text message)*

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Cancelof
Landowner signature for permission to pump off if meeting in person

Clear
Any additional considerations for pump off?
Date Obtained*

MonthDayYear
Date
Should be Empty:

Surface Water Discharge Checklist

For pumping water off any Teine lease