Document 71eDB9Yzrz2RgpVXYZ7p29deR
Inspection ID
Facility Contact Information
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
Inspector(s):
Carl E. Weller
_ (lead), ,
EPA Well ID#: F L S Year-Month-Day: 2 0 2
EPA Permit # (or RA):
Carol Chen
1 1 30 0 6 7 3 -03 - 28 FL I00 34
Page 1 Of 2
Start Time: 9:47 am End Time: 10:02 am
Facility Name: Street Address: City:
Black Creek Energy, LLC
4940 Blackjack Plant Rd.
Jay
County:
Santa Rosa
Nature of Business:
Oil and gas production
Facility Owner/Operator:
Black Creek Energy, LLC
Email:
Mike Wetzel <mikew2859@gmail.com>
Facility Contact (if different):
Michael Wetzel
O/O Mailing Address: 140 Virginia Street, Suite 302
City:
Richmond
County:
N/A
State: FL
Zip:32565-9260
Phone: 601-431-5386 Phone: 850-324-6271
State: VA Zip: 23219
Well Name & #: J. H. Wells #23
Well Type (see table): Enhanced Oil Recovery (EOR)
Latitude (N): 30.84893258
Longitude (W):
API No. 0911320130 PA No. 30253
State Permit:
-87.12033323
OG_ 693
Elevation (ft):
Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing
PBTD: 16025' Total Depth (ft): 16025'
Other: srfc csg 9" @3967'
Inner Casing Size (in):
Tubing Size (in):
cement plug Packer Depth (ft): 15040'
Inj. Zone: Open Hole; X Perforated; Top(ft) 15912' Bottom(ft): 15941' Max. Injection Pressure (psig): 2500'
Latitude (N):
30.84872
Longitude (W): -87.12039
Elevation (ft):
EPA GPS ID: SX8123 Well Status (see table): TA If not Active, Reported Date Last Active: 7/28/2006
Nature of Injected Fluid(s) if any:
General Condition of the Well Site:
Well Data from File
Field Measurements and Observations
Notes & Comments (include discrepancies from database values):
Well is planned for final closure, plugging and abandonment; was Temporarily Plugged and Abandoned
(TPA) on 7/28/2006. Report shows top of
Tubing gauge:
0 psi
cement was verified after hardening, at 15040'. Production gauge:
0 psi
Surface gauge:
0 psi
Injection well passed a mechanical integrity test: 8/24/2022
Name: Signature:
See reverse for additional observations, comments and photo log
UIC Inspector
UIC Inspector
Carl E. Weller
Digitally signed by CARL WELLER
CARL WELLER (Affiliate) (Affiliate)
Date: 2023.05.11 13:39:30 -04'00'
Name: Carol Chen
CAROL CHEN Date: 2023.05.10 20:00:55 -04'00' Digitally signed by CAROL CHEN
Signature:
Version 2018-04-18
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
(Cont)
EPA Well ID#: F L S 1 1 3 0 0 6 7 Year-Month-Day: 2 0 2 3 - 0 3 - 2 8
EPA Permit # (or RA): F L I 0 0 3 4 Page 2 Of 2
Field Measurements and Observations (Cont.)
Photo Log
Photographer: Photo ID: Description: Photo ID: Description:
Carl E. Weller
137
Time: 9:50 am
138
Time: 10:00 am
EPA Camera ID:
Lat (N): 30.84895 sign posted
Lat (N): 30.84872 photo of injection well
SX8123
Long (W)
-87.11993
Long (W)
-87.12039
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
Name: Signature:
Carl E. Weller
CARL WELLER (Affiliate)
Digitally signed by CARL WELLER (Affiliate) Date: 2023.05.11 13:40:00 -04'00'
UIC Inspector
Name:
Carol Chen
CAROL CHEN Date: 2023.05.10 20:01:24 -04'00' Digitally signed by CAROL CHEN
Signature:
Version 2018-04-18