Document EvdyJ6wzon3NzX6dpeoOmQV5L

DownloadSearchable PDFRandom document
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#: F L S 1 1 3 0 0 1 5 Year-Month-Day: 2 0 2 4 - 0 4 - 3 0 EPA Permit # (or RA): Phone: (404)562-9424 Page 1 Of 2 Inspector(s): _______C_a__r_o_l_C_h__e_n________________(lead) , ______C__a_r_la__F_o__y____________________ Start Time: _2__:1__1__p_m__ ____________________________________, ____________________________________ End Time: _2_:_1_9__p__m__ Facility Contact Information Facility Name:__M__a_v_e_r_i_c_k__N_a_t_u_r_a__l _R_e_s__o_u_r_c_e_s_,__L_L_C_____(_B_r_e_i_tb__u_r_n__O_p__e_r_a_t_in_g__L_P__)___________________________ Street Address:_5__4_1__5__O_i_l _P_l_a_n_t__R_d_______________________________________________________________________ City: _____J_a_y________________________ County: ___S__a_n_t_a__R_o__s_a_________________ State:___F_L____ Zip: _3__2_5__6_5__ Nature of Business: _____o_i_l _a_n_d__g_a__s_p__ro__d_u_c_t_i_o_n___________________________________________________________ Facility Owner/Operator: _M__a_v_e__r_ic_k__N__a_t_u_r_a_l_R__e_s_o_u__rc_e__s_,_L_L_C________________ Phone: _8__5_0__-6__7_5_-_1_7__0_2_________ Email: ________________________________________________________________________________________________ Facility Contact (if different): __A_l__J_o_n_e_s_,__P_l_a_n_t__S_u_p_e__r_in_t_e_n__d_e_n__t _______________ Phone: __2_5_1__-2__2_7__-3__3_1_9_________ O/O Mailing Address: ___5_4__1_5__O__il_P__la__n_t_R__d________________________________________________________________ City: ______J_a_y_______________________ County: ____S__a_n_t_a__R_o__s_a________________ State:__F_L_____ Zip: __3_2__5_6_5__ Well Data from File Well Name & #: __S__t.__R_e_g__is__P_a_p__e_r_C__o_m__p_a__n_y_(_S__R_P_C__)_#_8__-1______A__P_I_N__o_._0__9_1__1_3_2__0_0__2_5_____P__A__N_o_.__3_1_1__5_8__1__ 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: ____O_G____5__1_1_______________ Latitude (N): ______3_0__.9__5_8__0_3_3__________ Longitude (W): ______-8__7_._1_6__6_4_2__2_______ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing PBTD: 15,775' Smackover perforations 3 sets Other: __s_u_r_fa_c_e_c_a_si_n_g_1_0_3_/_4_" _to_3_,_6_2_8'__________________________________________ Total Depth (ft): 1__5_,_8_7__2_'__ Inner Casing Size (in): _8__3__/_4_"_ Tubing Size (in):__4__1_/_2_"___ Packer Depth (ft): _1_4_,_9_8__3_' Inj. Zone: Open Hole; X Perforated; Top(ft) 1__5_,_5_0__8_' Bottom(ft):1__5_,_6_4_0__' ___ 7,500 psi gas N2 Max. Injection Pressure (psig): 4_,4_0_0_p_s_i_P_W Field Measurements and Observations Latitude (N): ____3_0_._9_6_8__6_8_3_____________ Longitude (W): ____-_8_7__.1_8__2_2_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: __________________ Nature of Injected Fluid(s) if any: ______P__ro__d_u_c_e__d_W__a__te__r_s_(_P_W__)______________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): ______________________________________________________ DANGER sign posted: HS May Be Present..Authorized Personnel Only..Hazardous Operations..Keep Out... _____________________________________________________________________________________________________ _S_i_g_n__p_o_s_t_e_d__to__id__e_n_t_if_y_t_h_e__in__je_c_t_i_o_n_w__e_l_l._______________________________________________________________ _T_h_e__p__ro__d_u_c_e_d__w__a_t_e_r_s__fl_o_w__l_in__e__fe_l_t_h__o_t_t_o__t_h_e__to__u_c_h_.___________T_u_b_i_n_g_g__a_u_g_e_:________1__6_0_0__p_s_i___________ ______________________________________________________________P_r_o_d_u__c_ti_o_n__g_a_u_g_e_:_____0__p_s_i______________ ______________________________________________________________S_u__rf_a_c_e__g_a_u_g_e__: _______6_5__p_s_i_____________ ______________________________________________________________F_l_o_w__li_n_e_g__a_u_g_e_:_________________________ See reverse for additional observations, comments and photo log UIC Inspector UIC Inspector Name:_______C__a_r_o_l_C__h_e_n______________________________ Name: ______________________________________________ Signature: _C_A__R__O__L__C__H_E__N_______D_a_te_: _20_2_4._06_.2_0_2_1:_23_:2_5_-0_4_'0_0'___ Signature: ___________________________________________ 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#: F L S 1 1 3 0 0 1 5 Year-Month-Day: 2 0 2 4 - 0 4 - 3 0 EPA Permit # (or RA): Page 2 Of 2 (Cont) ________________________________________________________________________________________________ ______S_t_._R__e_g_i_s_P__a_p_e_r__C_o__m_p__a_n_y__(_S_R__P_C_)__#_8_-_1__________________________________________________________ _____________________________________________________________________________________________________ ________________________________________________________________S__m__a_c_k_o__v_e_r_P__e_r_fo__r_a_t_io_n__s_: ____________ ________________________________________________________________1__5_5__0_8_'_t_o__1_5__5_2__0_'_, _3_/_1__0_/_1__9_7_4_______ _________________________________________________________________1_5_5__8_1__' _to__1__5_6_0__7_'_,_4_/_0__7_/_1__9_7__2______ ________________________________________________________________1__5_6__1_6__' _to__1__5_6_4__0_'_, _4_/_0__7_/_1__9_7_2_______ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ P_h__o_t_o_I_D_:_R__IM__G_0__1_4_4_____T_i_m_e_:__2_:_1_5__p_m_______L_a_t__(__N_)_: __3__0_._9_6_8_7__0_2________L_o_n__g_(__W__)_:__-_8_7_._1_8__2_2_5_5_________ __b_l_u_r_ry__p_h__o_t_o_o__f_t_h_e__i_n_je__c_t_io_n__t_u_b__in_g__g_a__u_g_e___________________________________________________________ Photo Log Carol Chen S75332 Photographer:______________________________________EPA Camera ID: ______________________________________ Photo ID: ___R_IM__G__0_1_3__9_____Time: __2__:1__1_p__m___ Lat (N): ___3_0_._9_6__8_6_5_8_________ Long (W) ____-_8_7_._1_8_2__3_6_8________ Description: i_n_je__c_t_io_n__w__e_l_l,_p__o_s_t_e_d__w_i_t_h_w__e_l_l_i_d_e_n_t_i_fi_c_a_t_i_o_n__s_ig_n__a__n_d__D_A__N_G__E_R__s_i_g_n_:_H___S__M__a_y__b_e__P_r_e_s_e_n__t._._. _ Photo ID: __R__IM__G__0_1_4_0______Time: __2_:_1_1__p_m____ Lat (N): ___3_0__.9_6__8_6_5__7________ Long (W) ____-8__7_.1__8_2_3__8_3________ Description: __u_p_p__e_r_p_o__r_ti_o_n__o_f__th__e_i_n_j_e_c_t_i_o_n__w_e__ll________________________________________________________ Photo ID: ___R_I_M_G__0_1_4__1_____Time: __2_:_1_3__p_m____ Lat (N): ___3_0__.9_6__8_6___________ Long (W) ____-8__7_.1__8_2_2__7_2________ flow line Description: ___________________________________________________________________________________________ Photo ID: ___R_IM__G__0_1_4__2_____Time: __2_:_1_3__p_m____ Lat (N): ___3__0_.9__6_8_6__8_3________ Long (W) ____-8__7_.1__8_2_2__7_________ Description: __s_u_r_f_a_c_e__g_a__u_g_e__r_e_a_d__s_6__5__p_s_i______________________________________________________________ Photo ID: ___R_I_M__G_0_1__4_3_____Time: _2__:1__3_p__m____ Lat (N): ___3_0__.9__6_8_6___________ Long (W) ____-8_7__.1__8_2_2_7__5________ Description: __p_r_o_d__u_c_t_io__n__g_a_u_g__e_r_e_a__d_s__0__p_s_i____________________________________________________________ Photo ID: ___R_I_M__G_0_1__4_4_____Time: _2__:1__4_p__m____ Lat (N): ___3_0__.9__6_8_7___________ Long (W) ___-_8_7__.1_8__2_2_5__7________ Description: __i_n_j_e_c_t_io__n__tu__b_in__g__g_a_u_g_e__r_e_a__d_s__1_6_0__0__p_s_i___________________________________________________ UIC Inspector UIC Inspector Name:_____C__a_r_o_l_C__h_e_n_______________________________ CAROL Digitally signed by CAROL CHEN Signature: _____C__H__E_N__________D_a_te_: 2_0_2_4._06_.2_0______________ 21:23:51 -04'00' Name: ______________________________________________ Signature: ___________________________________________ Version 2018-04-18