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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 EPA Well ID#: K Y S 0 9 9 0 0 0 4 Year-Month-Day: 2 0 2 3 - 0 7 - 1 8 EPA Permit # (or RA): K Y I 0 3 8 9 Phone: (404)562-9424 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_:0__6__a_m__ ____________________________________, ____________________________________ End Time: _1_1_:_1_4__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: __________H_a__rt__________________ 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: __________H__a_r_t_________________ State:___K__Y___ Zip: __4_2__7_4_9__ Well Data from File Guinn #UA-3 Well Name & #: ________________________________________________________________________________________ Well Type (see table): ________E_n_h__a_n_c_e__d__O_i_l_R_e__c_o_v_e_r_y__(_E_O_R__)_________ State Permit: _________7_7__8_0__4___________ Latitude (N): ______3__7_._1_7__5_3_4__1_________ Longitude (W): ______-8__5_._7_8_9__2_3__6_______ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing PBTD: Other: __________________________________________________________________ Total Depth (ft): ___6_3__0_'___ Inner Casing Size (in): __4____"__ 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_7_7__5_2__8_________ Longitude (W): _______-8__5_._7_8__9_1_7________ Elevation (ft): ____________ EPA GPS ID: _S__X_8_1__2_3_ Well Status (see table): ___A__B____ If not Active, Reported Date Last Active: ___3_/_1__7_/_2__0_1_6_____ Nature of Injected Fluid(s) if any: __________________________________________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): ______________________________________________________ _<__H_OO_R_Z___E_X_F_N__H_W_S_O_D_F_H__G__R_Y_H_U__LQ__MH_F__WL_R_Q__w__e_l_l._W__e__ll_h_e_a__d__is__i_n_c_o_m__p__le__te__. _T_u_b_i_n_g__w__a_s__d_a_m___a_g_e_d__/_lo__s_t_. _____ _W__o_r_k_o_v__e_r_r_i_g_i_s__p_r_e_s_e_n__t_ly__o_n_s_i_t_e_._____________________T_u__b_i_n_g__G_a__u_g_e_:___________N__/_A___________________ _N_e__w__4___"__in__t_e_r_n_a_l_p__r_o_d_u_c__ti_o_n__c_a_s__in_g__w__a_s_____________P__r_o_d_u_c__ti_o_n__G__a_u_g__e_:______N__/_A___________________ _i_n_s_t_a_l_le__d_._M__a_t_e_r_i_a_l_s_a__re__s_e__e_n_,_w__i_th__in__t_h_e_______________S_u_r_f_a_c_e__G__a_u_g_e__: _________N__/_A___________________ _c_a_s_i_n_g_,_t_w__o__fe__e_t_d__o_w__n_.______________________________________________________________________________ _____________________________________________________________________________________________________ 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_.2_9 1_7_:44_:3_9 _-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_9_1_9:_01_:4_3_-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#: K Y Year-Month-Day: 2 0 S 0 2 3 9 9 - 0 0 0 7- 0 4 1 8 EPA Permit # (or RA): K Y I 0 3 8 9 Page 2 Of 2 (Cont) ____G_u_i_n_n__#__U_A__-3_____E_P__A__P_e__rm___it__N_o_.__K_Y_I_0_3__8_9_____S_t_a_t_e__P_e_r_m__i_t_N__o_._7__7_8__0_4________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 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__7_________Time: __1__1_:_0_7__a_m__ Lat (N): ____3__7_._1_7_7__5_2__8______ Long (W) ____-8__5_._7_8__9_1_7_________ Description: ____________________in__je_c__ti_o_n__w__e_l_l _c_l_o_s_e_-_u_p__________________________________________________ Photo ID: _____2_1__8_________Time: __1_1__:0__7__a_m__ Lat (N): _____3_7__.1__7_7_5__3_2______ Long (W) ____-8__5_._7_8_9__1_5_________ Description: ____________________in_j_e_c_t_i_o_n__w__e_ll__a_n_d__w__o_r_k_o_v__e_r_r_i_g_________________________________________ 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_.2_9_17_:4_7:_12_-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_.29_1_9_:0_2:_14_-0_4_'0_0'____ Digitally signed by CAROL CHEN Version 2018-04-18