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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 EPA Well ID#: K Y S 1 5 3 0 1 3 0 Year-Month-Day: 2 0 2 4 - 1 0 - 2 2 EPA Permit # (or RA): R A Phone: (404)562-9424 Page 1 Of 2 Inspector(s): _C_a__ro__l _C_h_e__n______________________ (lead),___L_o__n_n_ie__D__o_r_n____________________ Start Time:1_0__:0__0__a_m__ ____________________________________, ____________________________________ End Time:1__0_:_1_2__a_m__ Facility Contact Information Facility Name:___S__l_o_n_e__E__n_e_r_g__y_,_L_L__C____________________________________________________________________ Street Address:__8__9_6_6__K__Y__R__T__4_0__W__e__s_t_, _P__.O__._B__o_x__2_2__0__________________________________________________ City: _____O__il_S__p_r_in_g__s________________ County: _____M__a_g_o_f_fi_n___________________ State:__K_Y_____ Zip: _4_1__2_3_8___ Nature of Business: ___o__il_p__r_o_d_u__c_ti_o_n_____________________________________________________________________ Facility Owner/Operator: _____M__r.__S_.__C_h__ri_s__S_l_o_n__e_,_P__E______________________ Phone: _6_0_6__.2__9_7_._5_3__3_0__w__o_r_k____ Email: ________c_h__ri_s_s_lo__n_e_@__s_l_o_n_e_e__n_e_r_g_y_._c_o_m_____________________________________________________________ Facility Contact (if different): ________________________________________________ Phone: _6_0__6_.2__2_5_._2_2__0_6__c_e__ll_____ O/O Mailing Address: ____________________________________________________________________________________ City: _______________________________ County: _______________________________ State:________ Zip: _________ Well Data from File Well Name & #: _________J_.__H__._A__r_n__e__t_t_#__W___-_8__________________________________________________________ Well Type (see table): _C__la_s__s_I_I_-_R_,__E_n__h_a_n__c_e_d__O__il__R_e__c_o_v_e__ry__(_E__O__R_)__ State Permit: ______5_2__6_-_E__8_____________ Latitude (N): _____3_7__.7__0_7_2__1____________ Longitude (W): ____-8__3_._0_1_2__3_4___________ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; XTubing & Packer; Cemented Injection Tubing Other: __4____"_p_r_o_d__u_c_t_io__n__c_a_s_i_n_g__________________________________________ Total Depth (ft): __________ Inner Casing Size (in): __2____"__ Tubing Size (in):____1__"____ Packer Depth (ft): ________ Inj. Zone: Open Hole; Perforated; Top(ft) ________ Bottom(ft): ___________ Max. Injection Pressure (psig): ________ Field Measurements and Observations Latitude (N): ____3_7__.7__0_7_2__0_2____________ Longitude (W): ___-_8__3_._0_1_2__1_8_1__________ Elevation (ft): ____________ EPA GPS ID: _S_7__5_3_3_2__ Well Status (see table): ___A__C____ If not Active, Reported Date Last Active: __________________ Nature of Injected Fluid(s) if any: ___P__ro__d_u_c__e_d__W__a_t_e_r_s__(_P_W___)_______________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): ______________________________________________________ _____________________________________________________________________________________________________ _T__h_e__i_n_j_e_c__ti_o__n__li_n_e__i_s__c_o__n_n__e_c_t_e_d__,_f_e_e__ls__i_c_y__c__o_l_d_._P__r_o__d_u_c__e_d__w__a__te__r_s__a_r_e__b_e__in__g__i_n_j_e_c_t_e_d___to______ _e__n_h_a__n_c_e__o__il_r_e_c__o_v_e_r_y_.__N_o__g__a_u_g__e_s__w__e_r_e__a_t_ta__c_h_e__d__to__m__o_n__it_o_r__th__e__in__je_c__ti_o_n__a_n__d__a_n_n__u_l_u_s__p_r_e_s_s__u_r_e_s_. _T__h_e__w__e_l_lc_a__p__s_h_o__w_s__c_o__rr_o__s_io__n_._____________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ See reverse for additional observations, comments and photo log 8,&,QVSHFWRU UIC Inspector Carol Chen Name:______________________________________________ Name: ______________________________________________ Signature: _C_A__R__O__L__C_H__E__N_______D_a_te_: _20_2_4._12_.1_0_1_8:0_6_:2_1_-0_5_'00_' ___ Signature: ___________________________________________ Digitally signed by CAROL CHEN Version 2018-04-18 Inspection ID Field Measurements and Observations (Cont.) 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 EPA Well ID#: K Y S 1 5 3 0 1 3 0 Year-Month-Day: 2 0 2 4 - 1 0 - 2 2 EPA Permit # (or RA): R A Page 2 Of 2 (Cont) ________________________________________________________________________________________________ _________J__._H__.__A__R__N__E__T_T___#_W___-_8__________C__l_a_s__s__I_I_-R__,__E__n_h__a_n__c_e__d__O__i_l_R__e__c_o__v_e__r_y__(_E__O__R__)_______ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Photo Log Photographer:_C_a__ro__l _C_h_e__n___________________________EPA Camera ID: ____S__7_5_3__3_2___________________________ Photo ID: ___R__IM__G___0_1_8__7___Time: _1_0__:1__0__a__m__ Lat (N): ____3__7_._7_0_7__2_6_1_______ Long (W) ____-_8_3__.0__1_2_2__8_3_______ Description: _I_n_je_c__ti_o_n__w_e_l_l______________________________________________________________________________ Photo ID: ___R_I_M__G__0_1__8_8____Time: _1_0__:_1_0___a_m__ Lat (N): ____3__7_._7_0_7__2_0_2_______ Long (W) ____-_8_3_._0_1__2_1_8_1________ Description: _C_l_o_s_e_-_u_p__v_i_e_w__o_f__in_j_e_c_t_io_n__w__e_l_l _____________________________________________________________ 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: ___________________________________________________________________________________________ 8,&,QVSHFWRU UIC Inspector Carol Chen Name:______________________________________________ Name: ______________________________________________ Signature: _C_A__R__O_L__C__H__E_N________D_a_te_: 2_0_24_.1_2_.1_0 1_8_:0_6:_49_-_05_'0_0'____ Signature: ___________________________________________ Digitally signed by CAROL CHEN Version 2018-04-18