Document 07m4V7Y3OxqrB2d86b6QL85J
Inspection ID
Facility Contact Information
Class I and II Well Inspection Form
US Environmental Protection Agency - Region 4 Underground Injection Control Program
61 Forsyth Street SW, MC 9T25, Atlanta, Georgia, 30303 Phone: (404)562-9424
Inspector(s): Carl E. Weller
_ (lead),
,
EPA Well ID#: F L S
Year-Month-Day: 2 0 2
EPA Permit # (or RA):
Carol Chen
1 1 3 0 0 40 3 - 0 3 - 30 NO N E
Page 1 Of 2 Start Time: 12:29 pm End Time: 12:45 pm
Facility Name: Maverick Natural Resources, LLC (Breitburn Operating LP)
Street Address: 5415 Oil Plant Rd
City: Jay
County: Santa Rosa
State: FL Zip: 32565
Nature of Business: oil and gas production
Facility Owner/Operator: Maverick Natural Resources, LLC
Phone: 850-675-1702
Email:
Facility Contact (if different): Al Jones, Plant Superintendent
O/O Mailing Address: 5415 Oil Plant Rd
City:
Jay
County: Santa Rosa
Phone: 251-227-3319 State: FL Zip: 32565
Well Name & #:
R. D. Scott #41-5
Well Type (see table):
Enhanced Oil Recovery (EOR)
Latitude (N):
30.95108889
Longitude (W):
API No. 0911320187
PA No. 312062
State Permit:
OG_1002
-87.15776944 Elevation (ft):
Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing
PBTD: 15967'
Other:
surface casing 10" @3692'
Packer Otis WB
Total Depth (ft): 160271' Inner Casing Size (in):
Tubing Size (in):
Packer Depth (ft): 14348'
Inj. Zone: Open Hole; X Perforated; Top(ft) 15696' Bottom(ft): 15880' Max. Injection Pressure (psig):7500 psi N
Latitude (N):
30.95124
Longitude (W):
-87.15776
Elevation (ft):
EPA GPS ID: SX8123 Well Status (see table): AC If not Active, Reported Date Last Active:
Nature of Injected Fluid(s) if any: Nitrogen (N) gas injection
General Condition of the Well Site:
Well Data from File
Field Measurements and Observations
Notes & Comments (include discrepancies from database values): A T-disk was installed on the produced waters flowline, blocking such injection. The gas flowline was open, flowing.
Perforations:
15696' to 15762' (4SPF) 08/29/1984
Tubing gauge:
15764' to 15832' (4SPF) 08/28/1984
Production gauge
15839' to 15880' (4SPF) 08/28/1984
Surface gauge:
This well passed a mechanical integrity test on 4/13/2021.
5000 psi 0 psi 0 psi
See reverse for additional observations, comments and photo log
UIC Inspector
UIC Inspector
Name: Signature:
Carl E. Weller
CARL WELLER (Affiliate)
Digitally signed by CARL WELLER (Affiliate) Date: 2023.05.23 15:15:58 -04'00'
Name:
Carol Chen
CAROL CHEN Digitally signed by CAROL CHEN Date: 2023.05.22 14:27:49 -04'00'
Signature:
Version 2018-04-18
Inspection ID
Class I and II Well Inspection Form
US Environmental Protection Agency - Region 4 Underground Injection Control Program
61 Forsyth Street SW, MC 9T25, Atlanta, Georgia, 30303 Phone: (404)562-9424
(Cont)
EPA Well ID#: F L S 1 1 3 0 0 4 0 Year-Month-Day: 2 0 2 3 - 0 3 - 3 0
EPA Permit # (or RA): N O N E
Page 2 Of 2
Field Measurements and Observations (Cont.)
Photo Log
Photographer: Photo ID: Description: Photo ID: Description:
Carl E. Weller
EPA Camera ID:
SX8123
202
Time: 12:29 pm Lat (N): 30.95124
Long (W)
photo close-up of the sign posted onto the injection well
203
Time: 12:39 pm Lat (N): 30.95126 photo of injection well, taken several feet away
Long (W)
-87.15776 -87.15781
Photo ID:
Time:
Lat (N):
Long (W)
Description:
Photo ID:
Time:
Lat (N):
Long (W)
Description:
Photo ID:
Time:
Lat (N):
Long (W)
Description:
Photo ID:
Time:
Lat (N):
Long (W)
Description:
UIC Inspector
Name:
Carl E. Weller
CARL WELLER
Signature: (Affiliate)
Digitally signed by CARL WELLER (Affiliate) Date: 2023.05.23 15:16:32 -04'00'
UIC Inspector
Name: Carol Chen
CAROL CHEN Date: 2023.05.22 14:28:20 -04'00' Digitally signed by CAROL CHEN
Signature:
Version 2018-04-18