Document 4vQm3Y46rQVD8okVXM6gyEdgV

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#: F L S 1 1 Year-Month-Day: 2 0 2 4 - EPA Permit # (or RA): F L 30 0 0 4- I 00 8 0 3 0 5 2 Phone: (404)562-9424 Page 1 Of 2 Inspector(s): ______C_a_r_o_l_C__h_e_n___________________ (lead), ______C_a_r_la__F_o_y______________________ Start Time: _1__:1__8__p_m__ ____________________________________ , _______________________________________ End Time: _1__:3__8__p_m__ Facility Contact Information Facility Name:__M__a_v_e_r_i_c_k__N_a_t_u_r_a__l _R_e_s__o_u_r_c_e_s_,__L_L_C_____(_B_r_e_i_tb__u_r_n__O_p__e_r_a_t_in_g__L_P__)___________________________ Street Address:_5__4_1__5__O_i_l _P_l_a_n_t__R_d_______________________________________________________________________ City: _____J_a_y________________________ County: ___S__a_n_t_a__R_o__s_a_________________ State:___F_L____ Zip: _3__2_5__6_5__ Nature of Business: _____o_i_l _a_n_d__g_a__s_p__ro__d_u_c_t_i_o_n___________________________________________________________ Facility Owner/Operator: _M__a_v_e__r_ic_k__N__a_t_u_r_a_l_R__e_s_o_u__rc_e__s_,_L_L_C________________ Phone: _8__5_0__-6__7_5_-_1_7__0_2_________ Email: ________________________________________________________________________________________________ Facility Contact (if different): __A_l__J_o_n_e_s_,__P_l_a_n_t__S_u_p_e__r_in_t_e_n__d_e_n__t _______________ Phone: __2_5_1__-2__2_7__-3__3_1_9_________ O/O Mailing Address: ___5_4__1_5__O__il_P__la__n_t_R__d________________________________________________________________ City: ______J_a_y_______________________ County: ____S__a_n_t_a__R_o__s_a________________ State:__F_L_____ Zip: __3_2__5_6_5__ Well Data from File Well Name & #: _______M__c_M__i_ll_a_n__#_7__-1__0___________________________A__P_I_N__o_._0__9_-_1_1_3__-2__0_2__7_1_________________ Well Type (see table): ____E_n_h__a_n_c_e_d__O__il__R_e_c_o__v_e_r_y_(_E_O__R_)______________ State Permit: _______O_G____1_3__6_3___________ Latitude (N): ____3__0_._9__8__0__2__9_6__3__9_____ Longitude (W): ____-_8_7__.1__7_8__3_9_3__3_3______ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing PBTD: 15589' Other: ____s_u_rf_a_c_e__c_a_s_in_g__1_0_3__/_4_"_a_t_3_7_8__3____________________________________ Smackover Formation 4 1/2" at 15689' at 14111' 14111' Total Depth (ft): __1_5_6__8_9__' _ Inner Casing Size (in): ________ Tubing Size (in)3:_1_/_2__" _____ Packer Depth (ft): ________ Inj. Zone: Open Hole; X Perforated; Top(ft) _1_5_3__2_8__' Bottom(ft): __1_5__5_2__6_'__ Max. Injection Pressure (psig):7_1_2__0__p_s_i Field Measurements and Observations Latitude (N): _____3_0_._9_8__0_3__6_8___________ Longitude (W): _____-_8_7_._1_7__8_3__1_2________ Elevation (ft): ____________ EPA GPS ID: _________ Well Status (see table): ____A_C____ If not Active, Reported Date Last Active: __________________ Nature of Injected Fluid(s) if any: _____P__r_o_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): ______________________________________________________ D__A_N__G_E__R__s_ig_n__:__H__S__M__a_y__B_e__P_r_e_s__e_n_t_.._._A_u_t_h_o_r_i_z_e_d__P_e_r_s_o__n_n_e_l__O_n_l_y_.._._C_a_u__ti_o_n_._._H_a_z_a__rd__o_u_s__O_p__e_r_a_t_io__n_s_._..___ _T_h_e__P__ro__d_u_c_e__d__W__a_t_e_r_s_(_P_W__)__M__a_n_i_fo__ld__h_a__s_t_w__o__g_a_u_g__e_s_._I_n__a_d_d__it_io__n_,___T_u_b__in_g__g_a_u_g_e_: ______2_4__0_0__p_s_i______ _a__f_lo_w__li_n_e__g_a__u_g_e__a_t_t_h__e_i_n_j_e_c_t_io__n__w_e_l_l_r_e_a_d__s_2__3_0__0__p_s_i_. ________________P_ro_d_u_c_t_i_o_n_g_a_u_g_e_:___0__p_s__i _________ ______________________________________________________________________S_u_r_fa_c_e__g_a_u_g_e_: _____1_5__0__p_s_i_______ _L_o_w__l_a_d_d__ea_rt__in__je_c__ti_o_n__w__e_ll__w_i_t_h__li_g_h_t_-_y_e_ll_o_w__f_l_u_o_r_e_s_c_e__n_t_p__a_in__t_. _______F_lo_w__l_in_e__g_a_u_g_e_______2300 psi _____ ______________________________________H___O__M__a_n_i_f_o_ld__w__it_h__t_w_o__g_a__u_g_e__r_e_a_d__in_g__s_:_2_7__0_0__p__s_i,_2__3_5__0__p_s_i____ See reverse for additional observations, comments and photo log UIC Inspector UIC Inspector Carol Chen Name:_______________________________________________ Name: ______________________________________________ Signature: _C_A__R__O__L__C__H_E__N_______D_a_te_: _20_2_4._06_.2_0_2_1:_42_:4_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 Phone: (404)562-9424 EPA Well ID#: F L S 1 1 3 0 0 8 0 Year-Month-Day: 2 0 2 4 - 0 4 - 3 0 EPA Permit # (or RA): F L I 0 0 5 2 Page 2 Of 2 (Cont) ________________________________________________________________________________________________ _______M__c_M__i_ll_a_n__#__7_-_1_0_________S__ta__te__P__e_r_m__it_N__o_.__O_G____1_3__6_3___________A_P_I_N__o_._0__9_-_1_1__3_-_2_0_2__7_1____________ _________________________P_e__r_fo__ra__ti_o_n_s__(_S_m__a_c__k_o_v_e_r__F_o_r_m__a_t_i_o_n_)_:_____1_5_3__2_8__' _to__1__5_3__3_6_'_o__n__5_/_2_6__/_2_0__1_7__ __________________________________________________________________1__5_3__6_1_'_t_o__1_5__3_9__1_'_o_n__5__/_2_6__/_2_0__1_7__ __________________________________________________________________1__5_4_3__2_'_t_o__1_5__4_4__8_'_o_n__5__/_2_6__/_2_0_1__7__ __________________________________________________________________1__5_5_1__6_'_t_o__1_5__5_2__6_' _o_n__5__/_2_6_/__2_0_1__7__ _P_h_o_t_o_I_D_: _R__IM__G_0_1_2__5____T_im__e_: _1__:3__0_p__m______L_a_t__(_N__):_____3_0_._9_8_0_3_2__5_______L_o_n_g__(__W_)____-_8_7_._1_7_8_3__6____________ _v_ie__w__o_f_i_n_j_e_c_t_i_o_n__w_e__ll_w__it_h__f_lu__o_r_e_s_c_e_n__t_-y_e_l_l_o_w__p_a__in_t_e_d__l_o_w__e_r_s_t_a_i_r_c_a_s_e__a_n__d__D_A__N_G__E_R__s_i_g_n_:_H__2_S__.._.______ _P_h_o_t_o_I_D_:_R__IM__G_0_1_2__6____T_im__e_:__1_:3__1__p_m______L_a_t_(__N_)_:____3__0_.9_8__9_3_5_________L_o_n_g__(__W_)____-_8_7_._1_7_8_3__2_3___________ _b_a_c__k_o__f _t_h_e__in__je_c_t_i_o_n__w_e__ll_w__i_th__p_i_p_i_n_g__a_n_d__H___O__f_lo_w__li_n_e________________________________________________ P__h_o_to__ID__: _R_I_M_G__0_1_2_7_____T_im__e_:__1_:3__2__p_m_______La__t _(_N__):_____3_0_._9_8_0_4_4__3_______L_o_n_g__(_W__)____-_8_7_.1__7_8_2_9_____________ _s_u_r_f_a_c_e__g_a_u__g_e__r_e_a_d_s__1_5__0__p_s_i________________________________________________________________________ _P_h_o_to__ID__: _R__IM__G_0_1_2_8_____T_im__e_:__1_:3__2_p_m_______L_a_t_(__N_)_:____3__0_.9_8__0_4_2_________L_o_n_g_(__W__)____-8__7_.1_7__8_3_1_7____________ __a_n_n_u__lu__s_g_a__u_g_e__r_e_a_d__s_0__p__s_i_________________________________________________________________________ Photo ID: RIMG0129 Time: 1:35pm Lat (N): 30.980368 Long (W) -87.178312 _____________________________________________________________________________________________________ _c_l_o_s_e_-_u_p__o_f__tu__b_i_n_g__g_a_u_g__e_, _r_e_a_d__s_2__4_0_0__p__s_i ___________________________________________________________ Photo ID: RIMG0130 Time: 1:36 pm Lat (N): 30.98037 Long (W) -87.178285 _____________________________________________________________________________________________________ _f_l_o_w__li_n_e__g_a_u__g_e__a_t_2__3_0_0__p__s_i_________________________________________________________________________ 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_1_9______Time: __1_:_2_0__p_m____ Lat (N): ____N__o_G_P__S_0_0__0_______ Long (W) ___N_o__G_P_S__0_0_0__________ Description: _s_i_g_n__p_o__s_te__d__s_o_m__e__d_i_s_ta__n_c_e__f_r_o_m__t_h_e__i_n_j_e_c_t_io__n_w__e_l_l,__s_h_o_w__in__g__w_e_l_l_'s__id__e_n_t_if_i_c_a_t_io__n___________ Photo ID: ___R_I_M_G__0_1_2_0______Time: __1_:_2_4__p_m____ 30.958097 -87.188063 Lat (N): _____________________ Long (W) ______________________ Description: ___1__s_t_g_a__u_g_e__v_i_e_w_e__d__o_n__t_h_e__H__O__m__a__n_if_o_l_d__a_t_2__7_0__0__p_s_i_____________________________________ Photo ID: ___R__IM__G_0_1_2_1______Time: __1_:_2_5__p_m____ Lat (N): ____3_0_._9_6_3_4__7_8________ Long (W) ____-_8_7_._1_8_5_6__3_8________ Description: ____fa__rt_h_e__r_b_a__c_k__v_ie_w___o_f_t_h_e__1__s_t_g_a__u_g_e__o_n__t_h_e__H__O___m__a_n_i_fo__ld__a_t__2_7__0_0__p_s_i____________________ Photo ID: ___R__IM__G_0_1_2_2______Time: __1_:_2_5__p_m____ Lat (N): ____3__0_.9_7__6_9_8_________ Long (W) ____-_8_7_._1_7_9_3_4__3________ Description: ___d__if_f_e_r_e_n_t__a_n_g_l_e_,_1__s_t_g__a_u_g_e__o_n__t_h_e__H___O__m__a_n_i_f_o_l_d_a__t_2_7__0_0__p__s_i ____________________________ Photo ID: ___R__IM__G_0_1_2__3_____Time: __1_:_2_7__p_m____ 30.977561 -87.179343 Lat (N): _____________________ Long (W) ______________________ Description: _____2__n_d__g_a_u_g__e__v_ie_w__e_d__o_n__t_h_e__H___O__m__a_n_i_f_o_l_d_a__t_2_3__5_0__p__s_i __________________________________ Photo ID: RIMG0124 _________________ Time: __1_:_2_8__p_m____ Lat (N): ____3__0_.9_7__9_2_4_7________ Long (W) -87.178238 ______________________ farther back, overall view of the HO manifold with 2 gauges Description: ___________________________________________________________________________________________ UIC Inspector UIC Inspector Name:_____C__a_r_o_l _C_h_e_n_________________________________ Name: ______________________________________________ Signature: _C__A__R___O__L___C__H__E___N__D_a_t_e:_2_0_24_.0_6_.2_0_2_1_:4_3:_0_8_-0_4_'0_0'_ Signature: ___________________________________________ Digitally signed by CAROL CHEN Version 2018-04-18