Document 2Jvyq3JRaR6an3mKxXj4pYq4N
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 1 1 3 0 0 3 4
Year-Month-Day: 2 0 2 3 - 0 3 - 3 0 EPA Permit # (or RA): N O N E
Page 1 Of 2
Carol Chen
Start Time:11:15 am
End Time:11:22 am
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 & #: Well Type (see table): Latitude (N):
McDavid Lands #34-1
Enhanced Oil Recovery (EOR)
30.99079281
Longitude (W):
API No, 0911320111 PA No. 309897
State Permit:
-87.158975345
OG_658
Elevation (ft):
Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing
PBTD: 15721'
Other:
surface casing
Total Depth (ft): 15830' Inner Casing Size (in):
Tubing Size (in):
Packer Depth (ft): 15275'
Inj. Zone: Open Hole; X Perforated; Top(ft) 15444' Bottom(ft): 15498' Max. Injection Pressure (psig):
Latitude (N):
30.99078
Longitude (W):
-87.15897
Elevation (ft):
EPA GPS ID: SX8123 Well Status (see table): SI
If not Active, Reported Date Last Active:
Nature of Injected Fluid(s) if any:
General Condition of the Well Site:
Well Data from File
Field Measurements and Observations
Notes & Comments (include discrepancies from database values): A T-disk, showing the cross part, was installed on the nitrogen (N) flowline, blocking gas injection. The produced water flowline is open for injection,
without any T-disk, but there are no sounds of fluid flowing.
Perforations:
Tubing gauge:
15444' to 15498' (2SPF) 12/04/1980
Production gauge
Surface gauge:
This well passed a mechanical integrity test on 3/09/2023.
400 psi
0 psi 0 psi
Name: Signature:
See reverse for additional observations, comments and photo log
UIC Inspector
UIC Inspector
Carl E. Weller
Digitally signed by CARL WELLER
CARL WELLER (Affiliate) (Affiliate)
Date: 2023.05.23 15:12:20 -04'00'
Name:
Carol Chen
CAROL CHEN Digitally signed by CAROL CHEN Date: 2023.05.22 14:00:11 -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 3 4 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
200
Time: 11:13 am Lat (N):
30.99078
Long (W)
sign posted on the injection well itself, photo close-up
201
Time: 11:14 am Lat (N): 30.99084
Long (W)
photo of the injection well, several feet away
-87.15897 -87.15897
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 15:13:31 -04'00'
UIC Inspector
Name: Carol Chen
CAROL CHEN Date: 2023.05.22 14:00:45 -04'00' Digitally signed by CAROL CHEN
Signature:
Version 2018-04-18