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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 0 9 1 0 1 2 3 Year-Month-Day: 2 0 2 4 - 0 2 - 2 1 EPA Permit # (or RA): K Y A 0 3 6 2 Phone: (404)562-9424 Page 1 Of 2 Inspector(s): _______C_a__r_o_l_C_h__e_n________________ (lead),______B__r_ia_n__n_a__L_a_P__a_p_a_____________ Start Time: _2_:_0_1__p__m__ ____________________________________, ____________________________________ End Time: _2_:_0_3__p__m__ Facility Contact Information Facility Name:______W__e__s_t_K__e_n_t_u_c_k__y_E_n__e_r_g_y__R_e_s_o__u_r_c_e_s_,_L__L_C______________________________________________ Street Address:______3_8_3__0__V_i_n_c_e_n__t_S_t_a_t_i_o_n__D_r_i_v_e_________________________________________________________ City: ____O__w_e_n__s_b_o_r_o_________________ County: ______H_a_n__c_o_c_k__________________ State:___K_Y____ Zip: _4__2_3__0_3__ Nature of Business: ________O__il__a_n_d__g_a__s_e__x_tr_a_c_t_i_o_n________________________________________________________ Facility Owner/Operator: ____W__e_s_t__K_e_n__tu__c_k_y__E_n_e__rg__y_R__e_s_o_u__rc_e__s_,_L_L_C________ Phone: ____2__7_0_-_9__2_6_-_1_6__8_9______ Email: ______________G__le__n_R__i_d_g_e_s_:__2_7_0__-3__1_6__-7__4_8_7_______________________________________________________ Facility Contact (if different): _____V__in__c_e_n_t__B_._H__a_y_d_e__n_,_J_r_.,__M__a_n_a_g__e_r___________ Phone: ____2__7_0_-_6__8_3_-_3_0__5_7______ O/O Mailing Address: __________3_8_3__0__V_i_n_c_e_n__t_S_t_a_t_i_o_n__D_r_i_v_e________________________________________________ City: _____O__w_e__n_s_b_o__ro________________ County: ______H_a_n__c_o_c_k__________________ State:___K_Y____ Zip: __4_2_3__0_3__ Well Data from File Well Name & #: ____M__a_r_y_M__a__d_d_e_n__-R__ic_h__a_r_d_s__#_W__-_2________________________________________________________ Well Type (see table): ______E__n_h_a_n__c_e_d__O__il_R__e_c_o_v_e__ry__(_E_O__R_)___________ State Permit: __________________________ Latitude (N): _______3_7__.7__0_7_2__1_0_________ Longitude (W): ______-8__6_._7_1__8_7_3__3_______ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing Other: __________________________________________________________________ Total Depth (ft): __________ Inner Casing Size (in): __4____"__ Tubing Size (in):___1____"___ Packer Depth (ft): ________ Inj. Zone: Open Hole; Perforated; Top(ft) ________ Bottom(ft): ___________ Max. Injection Pressure (psig): __N_/__A___ Field Measurements and Observations Latitude (N): ______3_7_._7_0_7__9_6_5___________ Longitude (W): ______-_8_6_._7_1_9__1_7_3________ Elevation (ft): ____________ EPA GPS ID: _S_7__5_3_3__2_ Well Status (see table): ___A__B____ If not Active, Reported Date Last Active: ____N_o_n_e___________ Nature of Injected Fluid(s) if any: __________________________________________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): __T_h__e_M__a_r_y__M__a_d_d__e_n_-_R_i_c_h_a__rd__s_l_e_a_s__e_i_s_l_o_c_a__te__d__in_______ __R_e_y_n__o_l_d_s__S_t_a_t_io_n__,_K_e__n_t_u_c_k_y_,__4_2_3__6_8__. _______________________________________________________________ _W__e_ll_s__W__-2__, _W__-3__,_W__-_8_,_a_r_e__n_o__t _a_u_t_h_o__ri_z_e_d__b_y__P_e__rm__i_t_N__o_._K__Y_A_0__3_6_2__._O_n__ly__W__-1__,_W__-4__,_W__-_5_,_W__-_6__a_n_d__W__-_7_.__ The well is closed over, sealed shut, no open holes. No gauges are present. No flowlines. _____________________________________________________________________________________________________ Some corrosion. _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ See reverse for additional observations, comments and photo log UIC Inspector UIC Inspector Name:_______C_a__ro__l _C_h__e_n______________________________ Name:_____________________________________________ Signature: _C__A__R__O___L___C__H__E__N___D_a_te_:_2_02_4_.0_3_.2_7_1_6_:4_3:_2_1 _-0_4_'0_0'_ 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 EPA Well ID#: K Y S 0 9 1 0 1 2 3 Year-Month-Day: 2 0 2 4 - 0 2 - 2 1 EPA Permit # (or RA): K Y A 0 3 6 2 Phone: (404)562-9424 Page 2 Of 2 (Cont) _____M__a_r_y__M__a_d_d__e_n_-_R_i_c_h_a__rd__s_#__W__-2_______________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 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__6_6_____Time: __2__:0__4_p__m___ Lat (N): _____3_7__.7_0__7_9_6__5______ Long (W) ____-_8_6__.7_1__9_1_7__3_______ Description: ____in__je__c_ti_o_n__w__e_l_l _is__c_l_o_s_e_d__, _n_o_t__c_o_n_n__e_c_t_e_d_,__n_o__fl_o_w__l_i_n_e_s____________________________________ Photo ID: ___R_I_M__G_0_0__6_7_____Time: __2_:_0_4__p_m____ Lat (N): _____3_7__.7__0_7_9_6__5______ Long (W) _____-_8_6_._7_1_9__1_7_3_______ Description: ____c_l_o_s_e_-_u_p__o__f _in__je__c_ti_o_n__w__e_l_l,_s_h__o_w__in_g__t_o_p__o_f__w_e_l_l_i_s__s_e_a_l_e_d__o_v_e_r____________________________ Photo ID: ___R__IM__G_0__0_6_8_____Time: __2_:_0_4__p_m____ Lat (N): _____3_7__.7__0_7_9_6__5______ Long (W) ______-8_6__.7__1_9_1_7__3______ Description: _____p_h_o_t_o__t_a_k_e__n_a__l_it_t_le__f_a_r_t_h_e_r__f_ro__m__t_h_e__i_n_je__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: ___________________________________________________________________________________________ UIC Inspector UIC Inspector Name:_______C_a__ro__l _C_h__e_n____________________________ Name: ______________________________________________ CAROL CHEN Digitally signed by CAROL CHEN Date: 2024.03.27 16:43:47 -04'00' Signature: ___________________________________________ Signature: ___________________________________________ Version 2018-04-18