Michigan Department of Environmental Quality

Drinking Water and Municipal Assistance Division

Environmental Health Section
Phone: 517-284-5413 Fax: 517-241-1328

Please furnish to
Phone
Name

Address

City, State ZIP

Signature Date

Quantity Form Number Name

EQP 2044 Abandoned Well Plugging Record (50 per package)

EQC 2071 Michigan Well/Pump Code Book Part 127, 1978 PA 368 (each)

EQP 2017 Water Well & Pump Record (50 per package)

The DEQ no longer prints brochures. The fact sheets and brochures are
available on our water well construction webpage for download.

Mail requests to: DEQ, DWMAD

Environmental Health Section
Attention: Nicole Kiebler
P.O. Box 30241
Lansing, MI 48909-7741

FAX requests to: 517-241-1328

Email requests to: kieblern@michigan.gov

Rev. (4/2017)