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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 1 0 2 1 6 Year-Month-Day: 2 0 2 3 - 0 7 - 1 9 EPA Permit # (or RA): K Y A 0 3 6 2 Phone: (404)562-9424 Page 1 Of 2 Inspector(s): _____C_a_r_l_E__. _W__e_l_le__r_______________ (lead),_______C_a_r_o__l _C_h_e__n_________________ Start Time: _1_1__:1__1__a_m_ ____________________________________, ____________________________________ End Time: _1_1__:1__1__a_m_ Facility Contact Information Well Data from File Field Measurements and Observations Facility Name:_____W__e__s_t_K__e_n_t_u_c_k__y_E__n_e_r_g_y__R__e_s_o_u_r_c_e__s_,_L_L_C_______________________________________________ Street Address:_____3_8__3_0__V_i_n_c_e__n_t_S__ta__ti_o_n__D__r_iv_e__________________________________________________________ City: _____O__w__e_n_s_b__o_r_o_______________ County: ______H__a_n_c_o__c_k_________________ State:___K__Y___ Zip: _4__2_3__0_3__ Nature of Business: _____O__il__a_n_d__g_a__s_e__x_tr_a__c_ti_o_n___________________________________________________________ Facility Owner/Operator: ____W__e_s_t__K_e_n__t_u_c_k_y__E_n__e_r_g_y_R__e_s_o__u_r_c_e_s_,_L__L_C_______ Phone: ____2__7_0__-9__2_6_-_1_6__8_9______ Email: ___________________G__le__n_n__R_i_d_g__e_s_:__2_7_0__-3__1_6__-7__4_8__7_______________________________________________ Facility Contact (if different): ____M_r_._V__in__c_e_n_t__B_._H__a_y_d__e_n_,_J_r_._, _M__a_n_a__g_e_r_________ Phone: _____2_7__0_-_6_8_3__-3__0_5__7_____ O/O Mailing Address: _____3_8_3__0__V_i_n_c_e_n__t_S_t_a__ti_o_n__D__ri_v_e_____________________________________________________ City: ______O_w__e_n_s_b__o_r_o_______________ County: ______H_a__n_c_o_c_k__________________ State:___K_Y____ Zip: __4_2_3__0_3__ Well Name & #: ______M__a_r_y__M__a_d_d_e__n_-_R_i_c_h_a_r_d__s_#__W__-4______________________________________________________ Well Type (see table): ______E_n__h_a_n_c__e_d__O_i_l_R__e_c_o_v_e__ry__(_E_O__R_)___________ State Permit: __________________________ Latitude (N): ____3__7_._7_0__5_5_8_____________ Longitude (W): ______-8__6_._7_1_9__0_9_________ 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): ________ Latitude (N): _____3__7_._7_0_5__4_6__5__________ Longitude (W): ____-_8_6_._7_1__9_2__5_9_________ Elevation (ft): ____________ EPA GPS ID: _S_X_8__1_2__3_ Well Status (see table): ___A__B____ If not Active, Reported Date Last Active: __2__/_1_3__/_2_0__1_3_____ Nature of Injected Fluid(s) if any: __________________________________________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): _W__e__ll_s_a__r_e_l_o_c_a__te__d__in__R__e_y_n_o__ld_s__S__ta__ti_o_n__, _K_Y___4_2__3_6_8____ _T_a__ll_c__o_r_n_f_ie_l_d_s__i_m__p_e_d__e_d__t_h_e__p_a_t_h_w__a_y_,__s_o__in_s__p_e_c_t_o_r_s__in__s_t_e_a_d__t_o_o_k__p__h_o_t_o_s_,_a__t_t_h_e__e_d__g_e__o_f_t_h_e_________ _c_o__rn__fi_e_l_d_._T__h_e__in__je_c__ti_o_n__w__e_l_l _w__a_s__n_o_t__v_is_i_b_l_e_._N__o__ro__a_d_s__o_r__tr_a__il_s_._T_h__e_t_a_n__k__b_a_t_t_e_r_y__w_a__s_d_i_s_c_o__n_n_e_c__te__d_ from injection lines. No oil production. The well has been abandoned for many years. _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ See reverse for additional observations, comments and photo log UIC Inspector UIC Inspector Name:______C_a_r_l_E__. _W__e_l_le__r___________________________ Name: _______C__a_r_o_l_C__h_e_n_____________________________ Digitally signed by CARL WELLER (Affiliate) Signature:_C_A_R__L_W__E_L_L_E__R_(_A_f_fi_li_a_te_)_D_a_te_: 2_02_3._09_.0_1 1_6_:45_:2_6_-0_4'0_0'______ Signature: _C_A__R__O__L__C__H_E__N_______D_a_te_: _20_2_3._08_.3_1_1_7:_50_:5_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 EPA Well ID#: K Y S 0 9 1 0 2 1 6 Year-Month-Day: 2 0 2 3 - 0 7 - 1 9 EPA Permit # (or RA): K Y A 0 3 6 2 Phone: (404)562-9424 Page 2 Of 2 (Cont) ___K_Y_S__0_9__1_0_2__1_6_________M__a_r_y__M__a_d_d__e_n_-_R_i_c_h_a__rd__s_#__W__-_4___________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Photo Log Photographer:______C_a__rl__E_._W__e_l_l_e_r___________________EPA Camera ID: _____S_X_8__1_2__3__________________________ Photo ID: _____2__3_4_________Time: _1_0__:3_5___a_m___ Lat (N): _____3__7_._7_0_7__8_1__2_____ Long (W) _____-_8_6__.7__1_9__4_3_9______ Description: ______________________o_p__e_r_a_t_o_r_'s__s_i_g_n__o_n__t_h_e__p_r_o_p__e_r_t_y______________________________________ Photo ID: _____2_3__5_________Time: _1_0_:_3_5__a_m____ Lat (N): _____3_7__.7__0_7__8_0_9______ Long (W) _____-8__6_._7_1__9_4_4__8______ Description: ______________________ta__n_k__b_a__tt_e_r_y__a_n_d__o__p_e_r_a_t_o_r_'_s_s_i_g_n______________________________________ Photo ID: _____2_4__3_________Time: __1_1_:_1_1__a__m__ Lat (N): _____3__7_,_7_0__4_4_9__1_____ Long (W) _____-8__6_._7_1_5__0_7__3______ Description: ______________v_ie__w__o_f__ta__ll__c_o_r_n__fi_e_l_d_,_i_n_j_e_c_t_i_o_n__w_e__ll_i_s__n_o_t__v_is_i_b_l_e_____________________________ 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 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_fil_ia_t_e_)_D_a_te_: 2_02_3._09_.0_1_16_:4_6:_17_-0_4_'00_' _____ Digitally signed by CARL WELLER (Affiliate) Signature: _C_A__R__O_L__C__H__E_N________D_a_te_: 2_0_23_.0_8_.31_1_7_:5_1:_24_-0_4_'0_0'____ Digitally signed by CAROL CHEN Version 2018-04-18