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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 9 0 0 1 0 Year-Month-Day: 2 0 2 4 - 0 2 - 2 1 EPA Permit # (or RA): K Y I 0 4 2 0 Page 1 Of 2 Inspector(s): _____C__a_r_o_l_C__h_e_n__________________ (lead),______B_r_i_a_n_n__a__L_a_P_a__p_a_____________ Start Time:1__0_:_1_2__a_m__ ____________________________________, ____________________________________ End Time:1_0__:2__2__a_m__ Facility Contact Information Logsdon Valley Oil Co., Inc. Facility Name: __________________________________________________________________________________________ Street Address:______1__0_5__B__e_d_f_o_r_d__C_o__u_r_t________________________________________________________________ City: ____H_o_r_s_e__C__a_v_e_________________ County: Hart _______________________________ State:___K__Y___ Zip: _4__2_7__4_9__ Nature of Business: _______O_i_l_a_n__d__g_a_s__e_x_t_r_a_c_t_io__n_________________________________________________________ Facility Owner/Operator: ________L__o_g_s_d__o_n__V_a_l_le__y_O__il_C__o_._,_I_n_c_.______________ Phone: ____2__7_0_-_5_3__7_-_4_2__8_8______ Email: _______e_s__ti_n_s_o__n_@__s_c_r_tc__.c_o__m______________________________________________________________________ Facility Contact (if different): _____E_l_le_n__S__ti_n_s_o__n_,_P_r_e__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__fo__rd__C__o_u_r_t__________________________________________________________ City: ______H__o_r_s_e__C_a_v_e_______________ County: ________H_a_r_t____________________ State:____K_Y___ Zip: __4_2__7_4__9_ Well Data from File Well Name & #: ___________P_a__y_t_o_n___#_7__E_a__s_t_____________________________________________________________ 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: _______5__5_3_6__5_____________ Latitude (N): ______3_7__._1_9_3__9_0___________ Longitude (W): ______-_8_5__.7__7_6__9_9________ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; XTubing & Packer; Cemented Injection Tubing PBTD: Other: __7_"__s_u_r_f_a_c_e__c_a_s__in_g__t_o__2_6__8_'_______________________________________ Total Depth (ft): __6__3_3__' ___ Inner Casing Size (in): __4____"__ Tubing Size (in):___2____"___ Packer Depth (ft): __5_6__0_'__ Inj. Zone: Open Hole; Perforated; Top(ft) ________ Bottom(ft): ___________ Max. Injection Pressure (psig): ________ Field Measurements and Observations Latitude (N): ____3_7__.1__8_3_4__1_2____________ Longitude (W): ____-_8_5__.7__6_8__5_4_7_________ Elevation (ft): ____________ EPA GPS ID: _S_7_5__3_3__2_ Well Status (see table): ___A_C_____ If not Active, Reported Date Last Active: ____5__/_2_2__/_2_0__1_9___ Nature of Injected Fluid(s) if any: ______p_r_o_d_u__c_e_d__fl_u_id__s______________________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): __H__a_v_e__3_"__P_o_l_y_v_in__y_l _c_h_l_o_r_id__e__(P__V_C_)__fl_o_w__-l_in__e_s_.__________ _1__b_r_in__e__ta__n_k__n_e_a_r__in__je_c__ti_o_n__w__e_ll_._3__l_a_r_g_e_r_t_a_n__k_s__fo__r_p_r_o_d__u_c_t_io_n__a__c_ti_v_i_ti_e_s_._1__t_a_n__k_i_s__1_1_5__B__B_L__. __________ _1__t_a_n_k__is__2__1_0__B_B__L_._2__t_a_n__k_s__2_5_0__B__B_L__(_B_B__L_-__O_n__e_s__to_c__k_t_a_n__k__b_a_r_r_e_l_, _o_f_4__2__U_._S_._g__a_ll_o_n__s_l_iq__u_i_d_v_o__lu__m__e_)_. _C_a__n_h__e_a_r__p_r_o_d_u__c_e_d__w_a__te__rs__f_lo__w_i_n_g_._W__e_l_l_i_s_o__p_e_r_a_t_i_n_g__o_n__v_a_c_u_u__m__p__re__s_s_u_r_e_,_b__u_t_h_a__d__to__h_a__v_e___________ _i_n_je__c_t_io_n__p__u_m__p__to__o__p_e_r_a_t_e__t_h_is__w__a_y_._A_n__o__ld__i_n_je__c_t_io_n__p__u_m__p__is__n_e__a_r_b_y_,_l_o_o_k_i_n_g__c_o_r_r_o_d__e_d_.______________ _T_h__ic_k__w__ir_e_s__a_l_l_a_r_o_u__n_d__w_h__ic_h__c__o_u_l_d__h_a_v_e__e_l_e_c_t_r_ic_a__l _c_u_r_r_e_n_t__a_n_d__c_o__u_ld__s__h_o_c_k__y_o_u__. ____________________ __U_n__li_n_e_d__p_i_t_n__e_a_r__ta__n_k__b_a_t_t_e_r_y_.______________________________________________________________________ See reverse for additional observations, comments and photo log UIC Inspector UIC Inspector Name:_______C_a__r_o_l__C_h__e_n_____________________________ CAROL CHEN Digitally signed by CAROL CHEN Date: 2024.03.27 18:53:58 -04'00' Signature: ___________________________________________ Name: ______________________________________________ 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 EPA Well ID#: K Y S 0 9 Year-Month-Day: 2 0 2 4 - EPA Permit # (or RA): K Y 9 00 10 02 -2 1 I 04 20 Phone: (404)562-9424 Page 2 Of 2 (Cont) __U_I_C__C_l_a_s_s__I_I____P_a_y_t_o_n__#__7_E_a__s_t_________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ ___A_d_d_e_d_p_h__o_to_a_s__s_h_o_w_n__b_e_lo_w__.._. __ Photo ID:__R_I_M__G_0_0_4_0_______Time:__1_0_:_1_8_a_m_____Lat (N): ___3_7__.1_9_3__9_0_7________ Long (W) __-_8_5_.7__7_6_9________ Description: __i_n_je__c_ti_o_n__w_e_l_l _w_i_th__f_lo_w__l_in__e_s_c_o_n__n_e_c_t_e_d_,_c_o_v_e_r_e_d__b_y_b__e_d_d_i_n_g_m__a_t_e_r_ia__l _____________________ 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_I_M_G_0__0_3_4______ Time: _1_0_:_1_5__a_m____ Lat (N): ___3_7_._1_8_3_4__1_2________ Long (W) ____-_8_5_._7_6_8_5_4_7________ Description: ___1__b_r_i_n_e__ta__n_k__n_e_a__r_i_n_j_e_c_t_io_n__w__e_l_l_________________________________________________________ Photo ID: ___R__IM__G_0_0_3_5______Time: ___1_0_:1__6_a_m____ Lat (N): ___3__7_.1_8__3_4_1_2________ Long (W) _____-_8_5_._7_6_8_5__4_7_______ Description: ___i_n_j_e_c_t_io_n__w__e_l_l_c_l_o_s_e_-_u_p___________________________________________________________________ Photo ID: ___R_I_M_G__0_0_3_6______Time: __1__0_:1_6__a_m____ Lat (N): ___3_7_._1_9_3_9__4_8_______ Long (W) _____-8__5_.7_7__6_9_8_3______ Description: ___b__ri_n_e__ta__n_k__a_n_d__1_l_a_r_g_e_r_t_a_n_k__b_e_h__in_d__i_t _____________________________________________________ Photo ID: ___R_I_M_G__0_0_3_7______Time:___1_0_:_1_6__a_m_____Lat (N):____3_7_._1_9_3_8_9_8________ Long(W) ______-_8_5_._7_7_6_8_8________ Description: ____u_n_l_in_e__d_p__it_n_e__a_r_t_a_n_k__b_a_t_t_e_ry__f_o_r_p_r_o_d_u_c_e__d_f_l_u_id_s___________________________________________ Photo ID: __R__IM__G_0_0_3__8_____Time:___1__0_:1_7__a_m_____Lat (N):___3_7_._1_9_3_8_2__3_______ Long(W) -85.776864 ______________________ Description: ____3__la_r_g_e__t_a_n_k_s___________________________________________________________________________ Photo ID: __R_I_M__G_0_0_3_9______Time:___1_0__:1_7_a__m_____Lat 37.193773 (N):___________________ -85.776725 Long(W) _____________________ Description: ____3__la__rg_e__t_a_n_k_s__a_n_d__s_m__a_ll_e_r_b__ri_n_e__ta__n_k_c_o__n_n_e_c_t_e_d__to__i_n_je_c_t_i_o_n__w_e_l_l _w_i_th__f_lo__w__li_n_e_s______________ UIC Inspector UIC Inspector Carol Chen Name:_______________________________________________ Name: ______________________________________________ CAROL CHEN Digitally signed by CAROL CHEN Date: 2024.03.27 18:54:28 -04'00' Signature: ___________________________________________ Signature: ___________________________________________ Version 2018-04-18