Document 37N7Nvokv77bJMx6jpargJ0Xa
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 30 3 -03 NO N E
Page 1
Start Time:
End Time:
0 02 - 28
Of 2
2:04 pm 2:17 pm
Facility Name: Street Address: City:
Black Creek Energy, LLC
4940 Blackjack Plant Rd.
Jay
County:
Santa Rosa
Nature of Business:
Oil and gas production
Facility Owner/Operator:
Black Creek Energy, LLC
Email:
Mike Wetzel <mikew2859@gmail.com>
Facility Contact (if different):
Michael Wetzel
O/O Mailing Address: 140 Virginia Street, Suite 302
City:
Richmond
County:
N/A
State: FL
Zip:32565-9260
Phone: 601-431-5386 Phone: 850-324-6271
State: VA Zip: 23219
Well Name & #:
D. M. Kirkland #11-W
Well Type (see table):
Enhanced Oil Recovery (EOR)
Latitude (N): 30.87081983
Longitude (W):
API No. 091132013 PA No. 302532
State Permit:
-87.11947479
OG_ 729
Elevation (ft):
Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing
PBTD: 15890' Total Depth (ft): 16010'
Other: srfc csg @3926'
Inner Casing Size (in):
Tubing Size (in):
Packer Depth (ft): cement plug 15245'
Inj. Zone: Open Hole; X Perforated; Top(ft) 15847' Bottom(ft): 15873' Max. Injection Pressure (psig): 2500'
Latitude (N):
30.87179
Longitude (W):
-87.11970
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):
This well has communication between tubing and casing, needs repair, and is on the list.
for plugging and abandonment.
Tubing gauge: Production gauge:
0 psi 2000 psi
Surface gauge:
0 psi
Injection well passed a mechanical integrity test on 11/24/2020.
See reverse for additional observations, comments and photo log
UIC Inspector
UIC Inspector
Name: Carl E. Weller
Digitally signed by CARL WELLER
CARL WELLER (Affiliate) (Affiliate)
Signature:
Date: 2023.05.11 13:07:30 -04'00'
Name: Carol Chen
Signature: CAROL CHEN Date: 2023.05.10 18:33:39 -04'00' Digitally signed by CAROL CHEN
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 0 2
Year-Month-Day: 2 0 2 3 - 0 3 - 2 8
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
162
Time: 2:03 pm
163
Time: 2:04 pm
EPA Camera ID:
Lat (N): 30.87212 sign posted
Lat (N): 30.87179 photo of injection well
SX8123
Long (W)
-87.12012
Long (W)
-87.11970
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:
Name: Signature:
UIC Inspector
Carl E. Weller
CARL WELLER (Affiliate) Date: 2023.05.11 13:08:28 -04'00' Digitally signed by CARL WELLER (Affiliate)
UIC Inspector
Name:
Carol Chen
Signature: CAROL CHEN
Digitally signed by CAROL CHEN Date: 2023.05.10 18:34:11 -04'00'
Version 2018-04-18