Document 31yp6ore0eyMNEa9VkmaZ7jx

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 EPA Well ID#: K Y S 0 9 9 0 0 1 2 Year-Month-Day: 2 0 2 4 - 0 2 - 2 1 EPA Permit # (or RA): K Y I 0 6 6 3 Page 1 Of 2 Inspector(s): _____C__a_r_o_l_C__h_e_n__________________ (lead),______B_r_i_a_n_n__a__L_a_P_a__p_a_____________ Start Time: _9__:4_0__a_m___ ____________________________________, ____________________________________ End Time: _9__:4__5_a__m__ Facility Contact Information Logsdon Valley Oil Co., Inc. Facility Name: __________________________________________________________________________________________ Street Address:______1__0_5__B__e_d_f_o_r_d__C_o__u_r_t________________________________________________________________ City: ____H_o_r_s_e__C__a_v_e_________________ County: _______________________________ State:___K__Y___ Zip: _4__2_7__4_9__ Nature of Business: _______O_i_l_a_n__d__g_a_s__e_x_t_r_a_c_t_io__n_________________________________________________________ Facility Owner/Operator: ________L__o_g_s_d__o_n__V_a_l_le__y_O__il_C__o_._,_I_n_c_.______________ Phone: ____2__7_0_-_5_3__7_-_4_2__8_8______ Email: _______e_s__ti_n_s_o__n_@__s_c_r_tc__.c_o__m______________________________________________________________________ Facility Contact (if different): _____E_l_le_n__S__ti_n_s_o__n_,_P_r_e__s_id_e__n_t____________________ Phone: ____2_7__0_-_5_3__7_-_4_2__8_8______ O/O Mailing Address: ________1_0__5__B_e_d__fo__rd__C__o_u_r_t__________________________________________________________ City: ______H__o_r_s_e__C_a_v_e_______________ County: _______________________________ State:____K_Y___ Zip: __4_2__7_4__9_ Well Data from File Well Name & #: __________C__la__re__n_c_e__W__i_ls_o_n__#__3___________________________________________________________ Produced Water Disposal 87437 Well Type (see table): ______________________________________________ State Permit: __________________________ Latitude (N): __________________________ Longitude (W): ________________________ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; XTubing & Packer; Cemented Injection Tubing PBTD: Other: __________________________________________________________________ Total Depth (ft): __7__6_4__'___ Inner Casing Size (in):4___"__6_7__0' Tubing Size (in):___2___"____ Packer Depth (ft): __6_6__8_'__ Inj. Zone: Open Hole; Perforated; Top(ft) ________ Bottom(ft): ___________ Max. Injection Pressure (psig): ________ Field Measurements and Observations Latitude (N): ______3_7_._1_7_8__6_8__8__________ Longitude (W): _____-8__5_._7_8_7__9_6_6_________ Elevation (ft): ____________ S75332 AC EPA GPS ID: _________ Well Status (see table): _________ If not Active, Reported Date Last Active: __________________ Nature of Injected Fluid(s) if any: __________________________________________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): ______________________________________________________ _W__e__c_o_u_l_d__h_e_a__r_p_r_o_d__u_c_e_d__f_lu__id_s__f_lo__w_i_n_g__lo__u_d_l_y_,_w_i_t_h_o_u__t_a_n__i_n_je__c_t_io_n__p_u__m__p_,_o_n__a__v_a_c__u_u_m___p_r_o_c_e_s_s__. _____ _T_h__e__o_n_l_y_g_a__u_g_e__f_o_u_n__d__o_n_s_i_te__w__a_s__a_n__a_n__n_u_l_u_s__g_a_u__g_e_,_f_i_ll_e_d__w_i_t_h__a_n__o_i_ly__b_r_o_w__n_i_s_h__s_u_b_s_t_a_n__c_e_,_________ _n__o_t_o_p__e_r_a_t_in__g_p__r_o_p_e_r_l_y_. _T_h_e__t_a_n__k_b__a_t_te__ry__n_e__a_r_b_y__c_o_n_t_a_i_n_s__5__la__rg__e__c_y_li_n_d_e__rs__, _w_i_t_h__a_n__u_n_l_in__e_d__________ _p__it_a__lo__n_g__th__e__s_id__e_, _t_h_a_t__w_a__s_f_i_ll_e_d__w_i_t_h__p_r_o_d_u__c_e_d__f_lu_i_d_s__s_p_i_ll_a_g_e__. _____________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ See reverse for additional observations, comments and photo log Owner/Operator Representative (Optional) UIC Inspector Name:_______C_a__r_o_l__C_h__e_n_____________________________ CAROL CHEN Date: 2024.03.27 18:55:25 -04'00' Digitally signed by CAROL CHEN Signature: ___________________________________________ Name: ______________________________________________ Signature: ___________________________________________ 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 0 9 9 0 0 1 2 Year-Month-Day: 2 0 2 4 - 0 2 - 2 1 EPA Permit # (or RA): K Y I 0 6 6 3 Page 2 Of 2 (Cont) __U_I_C__C_l_a_s_s__I_I ___C__la__r_e_n_c_e__W__i_ls_o_n__#__3_____________________________________________________________ _____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Photo ID: ____R_IM__G_0_0__1_9_____ Time: _9_:_4_7__a_m_____ Lat (N): _____3_7_._1_7_8_8_9__6_______ Long (W) ____-_8_5_._7_8_7_7_9__7____ Description: _5__t_a_n_k__s_, _o_i_l _a_n_d__w_a__te__r_s_e_p_a__ra__ti_o_n__a_n_d__s_t_o_r_a_g_e_._1__l_a_r_g_e__ta__n_k__is__b_e_h_i_n_d__a_n_o__th__e_r_i_n_t_h_e__p_h__o_to____ Photo ID: ____R_I_M_G__0_0_2_0_____ Time: _9_:_4_8__a_m_____ Lat (N): _____3_7_._1_7_8_7_0__5_______ Long (W) ____-_8_5_._7_8_7_9__7_8____ Description: __I_n_je_c__ti_o_n__w_e_l_l_, _C_l_a_r_e_n_c_e__T_h_o_m__a_s__#_3_______________________________________________________ Photo ID: ____R_I_M_G__0_0_2_1_____ Time: 9__:4__8_a__m_____ Lat (N): ____3_7_._1_7_8_7_0__0________ Long (W) ___-8_5__.7_8__7_9_7______ Description: _c_l_o_s_e_-_u_p__o_f_i_n_j_e_c_t_io_n__w__e_ll_,_n_o__g_a_u__g_e_o__n_t_h_e__i_n_je__c_ti_o_n__l_in_e____________________________________ Photo ID: ____R_I_M__G_0_0_2_2_____ Time: _9_:_4_8__a_m_____ Lat (N): ____3_7_._1_7_8_6__8_8________ Long (W) ___-_8_5_._7_8_7__9_6_6____ Description: _r_e_d__d_is_h__c_o__rr_o_s_i_o_n__o_n__t_u_b_i_n_g_w__i_th__d_a_m__a__g_e_d__g_a_u_g_e__________________________________________ Photo ID: ____R_I_M__G_0_0_2_3_____ Time: _9_:_4_8__a_m_____ Lat (N): ____3_7_._1_7_8_6_8__8________ Long (W) ___-_8_5_._7_8_8__0_0_5____ Description: __a__n_o_t_h_e_r_l_o_o_k__a_t__th_e__a_n__n_u_l_u_s__g_a_u_g_e__f_ro__m__a__s_li_g_h_t__a_n_g_l_e____________________________________ Photo ID: ____R__IM__G_0_0_2__4____ Time: _9_:_4_8__a_m_____ Lat (N): ____3_7_._1_7_8_6_5__8________ Long (W) -85.788007 _________________ Description: __v_i_e_w__o_f__in_j_e_c_t_io__n_w__e_l_l _w_i_t_h_w__h_i_te__P_V__C__fl_o_w_l_i_n_e_s_____________________________________________ _____________________________________________________________________________________________________ Photo Log Photographer: _____B_r_i_a_n_n_a__L_a__P_a_p__a__________________EPA Camera ID: ________S_7__5_3_3__2_______________________ Photo ID: ___R_I_M_G__0_0_1_3______Time: _9__: _4_3___a_m___ Lat (N): ______3_7_._1_7_8_7__7_5______ Long (W) ___-_8_5_._7_8_7_7__7_3_________ Description: _v_i_e__w___o_f__t_a__n_k___b__a_t_t_e__r_y_,__a___d_i_s__t_a_n__c__e__a__w__a_y__________________________________________ Photo ID: ___R__IM__G_0_0_1_4______Time: _9__:4_3__a_m_____ Lat (N): ______3_7_._1_7_8__8_7_7______ Long (W) ___-8__5_.7__8_7_8_5__2_________ Description: _b_e__h_i_n__d___t _h_e___t_a_n__k___b_a__t_t_e_r__y_,__u_n__l_i_n__e_d___p_i_t__w__i_t_h___p_r_o__d__u_c__e_d___f_l_u_i_d__s________________ Photo ID: ___R_I_M__G_0_0_1_5______Time: _9__:4_3__a_m_____ Lat (N): ______3_7_._1_7_8__8_6_2______ Long (W) ____-8_5__.7_8__7_8_7_7_________ Description: _u__n_l_i_n__e_d___p_i_t__c__l _o_s__e_-_u__p_,__m___u_r_k__y__p__r_o_d__u__c_e__d__f_l_u__i_d_s__________________________________ Photo ID: ___R__IM__G_0_0_1__6_____Time: _9__:4_3__a_m_____ Lat (N): ______3_7__.1_7__8_8_4_1______ Long (W) ____-_8_5_.7__8_7_8_7__7________ Description:re__d_d_i_s_h_c_o__rr_o_s_i_o_n__d_o_w__n__th__e_s_i_d_e__o_f_t_a_n__k_, _b_l_a_c_k__u_n_d_e__rs_i_d_e__le__a_k_a_g_e__a_c_r_o_s_s__g_r_a_v_e_l_i_n_t_o__p_it_________ Photo ID: ____R_IM__G_0__0_1_7_____Time: __9_:_4_6__a_m____ Lat (N): ______3_7_._1_7_8_8_9__6______ Long (W) ____-_8_5_._7_8_7__8_4_5________ Description: w_h__it_e__p_o_l_yv_i_n_y_l_c_h__lo_r_i_d_e__(P__V_C_)_f_l_o_w_l_in__e_,_d_i_re__c_ti_n_g__f_lo_w__t_o__a_n_d__f_r_o_m__t_a_n_k_s__, _in_j_e_c_t_io__n_w__e_l_l,_e__tc_.______ Photo ID: ____R_IM__G_0_0__1_8_____Time: __9_:_4_6__a_m____ Lat (N): ______3_7_._1_7_8_9__2_1______ Long (W) ____-_8_5_._7_8_7__8_5_2________ Description: _c_l_o_s_e_-_u_p__b_e_t_w__e_e_n__ta__n_k_s____________________________________________________________________ Owner/Operator Representative (Optional) UIC Inspector Name:_______C__a_r_o__l _C__h_e__n___________________________ CAROL Digitally signed by CAROL CHEN Signature: __C__H__E_N__________1_8:_55_:_57_-_04_'0_0_' ________________ Date: 2024.03.27 Name: ______________________________________________ Signature: ___________________________________________ Version 2018-04-18