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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 4 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: _9_:_2_5__a_m___ ____________________________________, ____________________________________ End Time: _9_:_2_6__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: _____Oil Springs _______________ County:______M__a_g_o_f_f_in__________________ State:__K_Y_____ Zip: 41238 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 & #: _______S__A__L_Y__E_R__S___H__E_I_R__S__#__W__-_2_______________________________________________________ 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: __________________________ Latitude (N): _______3_7__.7__0_8_0__0__________ Longitude (W): ______-8__3_._0_1_6__2_5_________ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; XTubing & Packer; Cemented Injection Tubing Other: __4_____"_p__r_o_d__u_c_t_i_o_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): _____0__0_0__________________ Longitude (W): ____0__0_0_________________ Elevation (ft): ____________ EPA GPS ID: _S_7__5_3_3_2__ Well Status (see table): ___T_A_____ If not Active, Reported Date Last Active: ___7_/_1_2__/1__8________ Nature of Injected Fluid(s) if any: __________________________________________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): ______________________________________________________ _____________________________________________________________________________________________________ N__o__i_n_j_e_c_t_io__n__li_n_e__w__a_s__c_o_n__n_e_c__te__d__to__t_h_e__w__e_l_l,__a_n_d__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_1_1_1:_13_:0_6_-_05_'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 Phone: (404)562-9424 EPA Well ID#: K Y S 1 5 3 0 1 4 0 Year-Month-Day: 2 0 2 4 - 1 0 - 2 2 EPA Permit # (or RA): R A Page 2 Of 2 (Cont) ________________________________________________________________________________________________ _________S_A__L_Y__E_R__S__H__E_I_R__S__#_W___-2_______C_l_a_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__)___________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Photo Log Photographer:_____C__a_r_o_l_C__h_e_n_______________________EPA Camera ID: ___S__7_5_3_3__2____________________________ Photo ID: _R_I_M__G__0_1_7_7_______Time: __9_:2__6_a__m____ Lat (N): ______0_0_0_____________ Long (W) ______0_0_0______________ Description: _i_n_j_e_c_t_i_o_n__w__e_l_l____________________________________________________________________________ Photo ID: _R__IM__G__0_1__7_8______Time: __9_:_2_6__a_m____ Lat (N): ______0_0_0_____________ Long (W) _____0__0_0______________ Description: _in__je__c_t_i_o_n__w__e_l_l_, _f_a_r_t_h_e__r_b__a_c_k______________________________________________________________ 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_1 1_1_:1_3:_28_-_05_'0_0'____ Signature: ___________________________________________ Digitally signed by CAROL CHEN Version 2018-04-18