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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#: N O N E Year-Month-Day: 2 0 2 3 - 0 7 - 1 8 EPA Permit # (or RA): N O N E Page 1 Of 2 Inspector(s): _______C__a_r_l _E_._W__e__ll_e_r_____________ (lead),_______C_a_r_o__l _C_h_e__n_________________ Start Time: 1__1_:_2_3__a_m__ ____________________________________, ____________________________________ End Time: _1_1_:_2_5__a_m__ Facility Contact Information Logsdon Valley Oil Co., Inc. Facility Name: __________________________________________________________________________________________ Street Address:_____1_0__5__B_e_d__fo__rd__C__o_u_r_t__________________________________________________________________ City: ______H__o_r_s_e__C_a_v_e_______________ County: _______________________________ State:___K__Y___ Zip: __4_2__7_4__9_ Nature of Business: ______O__il_a__n_d__g_a_s__e_x__tr_a_c__ti_o_n__________________________________________________________ Facility Owner/Operator: ____L_o__g_s_d_o_n__V__a_l_le_y__O__il_C__o_._, _In__c_.__________________ Phone: ______2_7_0__-5__3_7__-4__2_8_8_____ Email: ______e_s_t_in__s_o_n_@__s_c_r_t_c_.c__o_m__________S__p_e_n__c_e_r_W___a_lt_e_r_s__s_c_w__1_0__6_@__g_m__a_i_l_.c_o__m_________________________ Facility Contact (if different): _____E_ll_e_n__S__ti_n_s_o__n_,_P__re__s_id__e_n_t____________________ Phone: ______2_7__0_-_5_3__7_-_4_2_8__8____ O/O Mailing Address: _____1_0__5__B_e__d_f_o_r_d__C_o_u__rt_____________________________________________________________ City: _____H__o_r_s_e__C_a_v_e________________ County: ___in_j_e_c_t_io_n__well: _B_a___r_r__e__n__________ State:___K__Y___ Zip: __4_2__7_4_9__ Well Data from File Billy Joe Caudel #UIC-1 Well Name & #: ________________________________________________________________________________________ Produced Water Disposal Well Type (see table): ______________________________________________ State Permit: ____1_1__1_1__4_3_______________ Latitude (N): ________3_7_._1_5__9_7__7_________ Longitude (W): ________-8__5_._7_9_6__2_8_______ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing PBTD: Other: __________________________________________________________________ Total Depth (ft): __________ Inner Casing Size (in): ________ Tubing Size (in):__________ Packer Depth (ft): ________ Inj. Zone: Open Hole; Perforated; Top(ft) ________ Bottom(ft): __________ Max. Injection Pressure (psig): ________ Field Measurements and Observations Latitude (N): _______3_7__.1__5_9__7_9__________ Longitude (W): ______-_8_5_._7_9__6_2__8________ Elevation (ft): ____________ EPA GPS ID: _S__X_8_1__2_3_ Well Status (see table): ____A_B____ If not Active, Reported Date Last Active: __7__/_3_0__/_2_0__1_9_____ Nature of Injected Fluid(s) if any: __________________________________________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): ______________________________________________________ _U_n_c_o__n_f_in__e_d__p_i_t,__b_l_a_c_k_e_n__e_d__d_e_a__d__tr_e__e_s_.______________________________________________________________ _M__e_t_a_l_li_c__e_n_c_l_o_s_u__re__i_s__h_e_a_v_i_l_y_c_o__r_ro__d_e_d_,__c_o_l_la__p_s_e_d_.____T_u__b_i_n_g__G_a__u_g_e_:_________N_/_A______________________ _I_n_je__c_t_io_n__w__e_l_l_i_s_d__is_c_o__n_n_e__c_te__d__fr_o_m___t_h_e__i_n_j_e_c_t_io__n____P_r_o_d__u_c_t_io__n___G__a_u_g__e_:_ N/A ___________________________ _l_in__e_._A_n__n_u_l_u_s__g_a_u__g_e__is__n_o__n_-_fu__n_c_t_io__n_i_n_g_._______________S_u_r_f_a_c_e__G__a_u_g_e__: _______N_/__A_____________________ _T_a_n__k__b_a_t_t_e_r_y_s_h__o_w__s_e__v_id__e_n_c_e__o_f__p_r_e_v_i_o_u_s__s_p__il_la__g_e__fr_o__m__t_h_e__t_o_p__w__h_e_r_e__a__p_i_p_e__w__a_s__c_o_n_n__e_c_t_e_d_,_______ _a_s__f_lu__id_s__d_r_a__in_e__d_.___________________________________________________________________________________ See reverse for additional observations, comments and photo log Owner/OpeUraICtoInr sRpeepcrteosrentative (Optional) UIC Inspector Carl E. Weller Name:_______________________________________________ Name: ________C__a_r_o_l_C__h_e_n____________________________ Signature: _C_A_R__L_W__E_L_L_E_R__(_A_f_fi_lia_t_e_)_D_a_te_: 2_02_3._08_.3_0 1_1_:08_:3_0 _-04_'0_0'______ Signature: _ Digitally signed by CARL WELLER (Affiliate) C_A__R__O__L__C_H__E__N_______D_a_te_: _20_2_3._08_.2_2_1_1:_30_:4_7_-0_4_'0_0'___ 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#: N O N E Year-Month-Day: 2 0 2 3 - 0 7 - 1 8 EPA Permit # (or RA): N O N E Page 2 Of 2 (Cont) ____B_i_ll_y__J_o_e__C_a_u__d_e_l_#__U_I_C_-_1_______S__t_a_t_e__P_e_r_m__i_t_N__o_._1__1_1_1__4_3______________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Photo Log Photographer:_______C_a__rl__E_._W__e__ll_e_r__________________EPA Camera ID: __________S_X_8__1_2__3_____________________ Photo ID: ______2_1__9________Time: __1_1__:2__3__a_m__ Lat (N): _____3_7__.1__5_9_7__9_______ Long (W) ______-8__5_._7_9_6__2_8_______ Description: ______________________i_n_j_e_c_t_io__n__w_e_l_l_c_l_o_s_e__-u_p________________________________________________ Photo ID: ______2__2_0________Time: __1_1_:_2_4__a_m___ Lat (N): ____3__7_._1_5__9_7__7_______ Long (W) _____-_8_5__.7__9_6__2_5_______ Description: _______________v_ie__w__o_f__in__je_c__ti_o_n__w__e_l_l _a_n_d__p__ro__d_u_c_e__d__fl_u_i_d_s__t_a_n_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: ___________________________________________________________________________________________ Owner/OperUaICtoIrnRseppercetoser ntative (Optional) UIC Inspector Name:_____C__a_r_l_E_._W___e_ll_e_r_____________________________ Name: _______C_a_r_o_l__C_h_e__n_____________________________ Signature: _C_A_R__L_W__E_L_L_E_R__(_A_f_fi_lia_t_e_)_D_a_te_: 2_02_3_.08_.3_0_11_:0_9:_01_-0_4_'00_' _____ Signature: _ Digitally signed by CARL WELLER (Affiliate) C_A__R__O_L__C__H__E_N________D_a_te_: 2_0_23_.0_8_.22_1_1_:3_1:_14_-0_4_'0_0'____ Digitally signed by CAROL CHEN Version 2018-04-18