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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 Phone: (404)562-9424 EPA Well ID#: K Y S 0 9 1 0 1 2 1 Year-Month-Day: 2 0 2 4 - 0 2 - 2 1 EPA Permit # (or RA): K Y A 0 3 6 2 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: _1_:_0_8__p_m___ ____________________________________, ____________________________________ End Time: _1__:1_0__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__-_6________________________________________________________ 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_4__1_9__________ Longitude (W): ______-_8_6__.7__1_6_7__8________ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing Other: __________________________________________________________________ Total Depth (ft): ____2_6__6_'__ Inner Casing Size (in): ___5_"____ Tubing Size (in):____2__" ____ Packer Depth (ft): ________ Inj. Zone: Open Hole; Perforated; Top(ft) ________ Bottom(ft): ___________ Max. Injection Pressure (psig): __2_1__0___ Field Measurements and Observations Latitude (N): _____3__7_._7_0_4_1__6_7___________ Longitude (W): _____-8__6_.7__1_6_3__8_9_________ Elevation (ft): ____________ EPA GPS ID: _S_7__5_3_3__2_ Well Status (see table): ___A_B_____ If not Active, Reported Date Last Active: __1_2__/_0_5_/_1_9__9_0_____ 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__a__n_d__W__-_3__a_r_e_n__o_t_a__u_t_h_o_r_i_z_e_d__b_y__P_e_r_m__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_.__ Today's inspection confirms his well is no longer in the area where it was once located. It has _____________________________________________________________________________________________________ _b__e_e_n__s_a_i_d__th__e__w_e_l_l_w__a_s__p_lu__g_g_e_d__, _w_i_t_h_o_u_t__p_r_io__r_n_o__ti_c_e__b_e_f_o_r_e_h__a_n_d_.____________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 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_2:_2_2 _-0_4_'0_0'_ Digitally signed by CAROL CHEN 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 1 0 1 2 1 Year-Month-Day: 2 0 2 4 - 0 2 - 2 1 EPA Permit # (or RA): K Y A 0 Page 2 36 2 Of 2 (Cont) ____M__a_r_y__M__a_d_d__e_n_-_R_i_c_h_a__rd__s_#__W__-6________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Photo Log Photographer:__________B_r_ia_n_n__a_L_a__P_a_p_a_____________ EPA Camera ID: ________S_7_5_3__3_2________________________ Photo ID: ____R_IM__G__0_0_4__1____Time: __1_:_1_3__p_m____ Lat (N): _____3_7_._7_0__4_1_6_7_______ Long (W) _____-_8_6_._7_1_6__3_8_9_______ Description: ___p_h_o_t_o__o_f__in__s_p_e_c_t_i_o_n__r_e_p_o_r_t_______________________________________________________________ Photo ID: ___R__IM__G_0__0_4_2_____Time: __1_:_1_3__p_m____ Lat (N): _____3_7__.7_0__4_1_6__7______ Long (W) ______-8__6_.7__1_6_3__8_9______ Description: ___M__a_r_y__M__a_d_d_e__n_-_R_i_c_h_a_r_d_s__#__W__-6__i_s_n__o_t_v_i_s_i_b_l_e_i_n__t_h_e__e_m__p_t_y__c_o_r_n_f_ie__ld__p_l_o_t___________________ 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: ___________________________________________________________________________________________ UIC Inspector UIC Inspector Name:_______C_a__ro__l _C_h__e_n____________________________ Name: ______________________________________________ CAROL CHEN Date: 2024.03.27 16:42:48 -04'00' Digitally signed by CAROL CHEN Signature: ___________________________________________ Signature: ___________________________________________ Version 2018-04-18