Document ExDqkq5QZ7YZg0LvRyL08eGkn

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 1 2 4 Year-Month-Day: 2 0 2 4 - 0 2 - 2 1 EPA Permit # (or RA): K Y A 0 3 6 2 Phone: (404)562-9424 Page 1 Of 2 Inspector(s): _______C_a__r_o_l_C_h__e_n________________ (lead),______B__r_ia_n__n_a__L_a_P__a_p_a_____________ Start Time: _1_:_4_5__p_m___ ____________________________________, ____________________________________ End Time: _1_:_5_0__p_m___ Facility Contact Information 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_t_a_t_i_o_n__D_r_i_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__ Nature of Business: ________O__il__a_n_d__g_a__s_e__x_tr_a_c_t_i_o_n________________________________________________________ Facility Owner/Operator: ____W__e_s_t__K_e_n__tu__c_k_y__E_n_e__rg__y_R__e_s_o_u__rc_e__s_,_L_L_C________ Phone: ____2__7_0_-_9__2_6_-_1_6__8_9______ Email: ______________G__le__n_R__i_d_g_e_s_:__2_7_0__-3__1_6__-7__4_8_7_______________________________________________________ Facility Contact (if different): _____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_t_i_o_n__D_r_i_v_e________________________________________________ City: _____O__w_e__n_s_b_o__ro________________ County: ______H_a_n__c_o_c_k__________________ State:___K_Y____ Zip: __4_2_3__0_3__ Well Data from File Well Name & #: ____M__a_r_y_M__a__d_d_e_n__-R__ic_h__a_r_d_s__#_W__-_3________________________________________________________ Well Type (see table): ______E__n_h_a_n__c_e_d__O__il_R__e_c_o_v_e__ry__(_E_O__R_)___________ State Permit: __________________________ Latitude (N): ________3_7_._7_0__6_8__8_________ Longitude (W): _______-_8_6__.7__1_6__4_2_______ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing Other: __________________________________________________________________ Total Depth (ft): 232' __________ Inner Casing Size (in): _7_"_a_t__2_1_9"Tubing Size (in):___2_"______ Packer Depth (ft): ________ Inj. Zone: Open Hole; Perforated; Top(ft) ________ Bottom(ft): ___________ Max. Injection Pressure (psig): __N__/_A___ Field Measurements and Observations Latitude (N): __________________________ Longitude (W): ________________________ Elevation (ft): ____________ EPA GPS ID: _S_7__5_3_3_2__ Well Status (see table): ___A__B____ If not Active, Reported Date Last Active: ____N_o_n_e___________ Nature of Injected Fluid(s) if any: __________________________________________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): __T_h__e_M__a_r_y__M__a_d_d__e_n_-_R_i_c_h_a__rd__s_l_e_a_s__e_i_s_l_o_c_a__te__d__in_______ __R_e_y_n__o_l_d_s__S_t_a_t_io_n__,_K_e__n_t_u_c_k_y_,__4_2_3__6_8__. _______________________________________________________________ _W__e_l_ls__W__-_2_,__W__-3__, _W__-8__,_a_r_e__n_o_t_a__u_t_h_o_r_i_z_e_d__b_y_P__e_r_m__it__N_o_._K__Y_A_0__3_6__2_._O__n_l_y_W__-_1_,_W__-_4_,_W__-_5_,_W__-_6__a_n_d__W__-7__.__ _O__n__7_/_1_9__/_2_3__,_t_h_i_s_w__e_l_l _w_a__s_h__id__d_e_n__a_t__th__e__ti_m__e_,_b__y_t_h_e__t_a_l_l _c_o_r_n_f_i_e_ld__._S_i_n_c_e__t_h_e__c_o_r_n__w__a_s__r_e_m__o_v_e_d__, ___ __w_e__c_a_n__s_e__e_t_h_i_s__w_e_l_l_n_o__w_._W__e__f_i_n_d__n_o__in__je_c__ti_o_n__li_n_e__a_n__y_w_h__e_r_e_._T_h_e__w__e_l_l _is__d_i_s_c_o_n__n_e_c_t_e_d__. _N_o__g_a__u_g_e_s___ _a__re__p__re__s_e_n_t_._W__e__s_e_e__e_v_i_d_e_n__c_e__o_f_t_h_i_c_k_,_b__la_c_k__e_n_e_d__c_r_u__d_e__o_il_,_c_o__v_e_r_in_g__m__u_c__h_o__f _t_h_e__w_e__ll_, _in__a__d_d_i_ti_o_n____ _t_o__c_ir_c_l_in__g_i_t_s_b__a_s_e_,__th__e_r_e_u__p_o_n__t_h_e__m__u_d__a_n__d_b__r_a_m__b_l_e_s_,_j_u_s_t_b__e_n_e_a__th__. ________________________________ See reverse for additional observations, comments and photo log UIC Inspector UIC Inspector Name:_______C_a__ro__l _C_h__e_n______________________________ Name:_____________________________________________ Signature: _C__A__R___O__L___C__H__E___N__D_a_t_e:_2_0_24_.0_3_.2_7_1_6_:4_4_:2_0_-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 EPA Well ID#: K Y S 0 9 1 0 1 2 4 Year-Month-Day: 2 0 2 4 - 0 2 - 2 1 EPA Permit # (or RA): K Y A 0 3 6 2 Phone: (404)562-9424 Page 2 Of 2 _(_C_o_n_t)_M__a_r_y__M__a_d_d_e__n_-_R_i_c_h_a_r_d_s__#__W__-3___________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Photos continued... ____________________________________________________________________________________________________ Photo ID: ____R_I_M_G__0_0_5_7_____ Time: __1_:_4_5__p_m____ Lat (N): ___3_7__.7__0_6_9_1__2_____Long (W)______-8_6__.7__1_6_1_1__7______ Description: ___C_l_o_s_e_-_u_p__p_h__o_t_o__o_f_i_n_j_e_c_t_io_n__w__e_l_l_______________________________________________________ Photo ID: ____R_IM__G_0_0__5_8_____ Time: __1_:_4_6__p_m____ Lat (N): ___3__7_.7__0_6_8__7_3_____Long (W)______-8__6_.7__1_6_3__5_8______ Description: ___a__d_if_f_e_r_e_n_t__a_n_g__le__o_f__th__e_i_n_j_e_c_t_i_o_n__w_e__ll___________________________________________________ ____________________________________________________________________________________________________ Photo ID: ____R_I_M__G_0_0_5_9_____ Time: __1_:_4_8__p_m____ Lat (N): ___3__7_.7__0_6_8__9_3_____Long (W)______-8__6_._7_1_6_3__8_1______ Description: ___p_h__o_t_o_t_a_k__e_n__fa__r_th__e_r_a__w_a_y__f_r_o_m__t_h_e__i_n_j_e_c_t_io__n_w__e_l_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_5_1______Time: ___1_:_3_7__p_m___ Lat (N): ____3__7_.7__0_5_5__1_8_______ Long (W) _____-_8_6_._7_1_9__0_1_7_______ Description: p_h_o_t_o__o_f__in_s_p__e_c_t_io__n_r_e__p_o_r_t_/_n_o_t_n__e_e_d_e__d__h_e_r_e_._T_h__is__w__e_ll__is__a__p_r_o_d_u_c__e_r_, _n_o_t__a_n__in__je_c_t_o_r_._________ Photo ID: ___R__IM__G_0_0_5__2_____Time: __1__:3__8_p__m___ Lat (N): ____3__7_.7__0_5_5__1_8_______ Long (W) _____-_8_6_._7_1__9_0_1_7_______ Description: _v_i_e__w___o__f __a_n___a__c_t_i_v__e__p__r_o__d_u__c__t_i _o_n___w__e__l l______________________________________________ Photo ID: ____R_IM__G_0_0__5_3_____Time: __1__:3__8_p__m___ Lat (N): ____3__7_._7_0_5_5__1_8_______ Long (W) _____-_8_6__.7_1__9_0_1__7______ Description: _c__lo_s_e__-u__p__o_f_t_h_e__p_r_o_d__u_c_e_r__________________________________________________________________ Photo ID: ____R_IM__G_0__0_5_4_____Time: ___1_:_3_8__p_m___ Lat (N): _____3_7__.7__0_5_5_1__8______ Long (W) ______-8_6__.7__1_9_0_1__7______ Description: _j_u_s_t__d_o_w__n_h__il_l _o_f_t_h_e__p__ro__d_u_c_e__r,__w_e__o_b__s_e_r_v_e_d__a__c_r_e_e_k_,__v_e_r_y_c__lo_s_e__t_o__t_h_e__p_r_o_d_u__c_e_r____________ Photo ID: ____R_IM__G_0__0_5_5_____Time: ___1_:_4_5__p_m___ Lat (N): _____3__7_._7_0_6_8__9_5______ Long (W) ______-8__6_.7__1_6_4__1_6______ Description: _p_h_o_t_o__o_f__in_s__p_e_c_t_i_o_n__re__p_o_r_t_f_o_r__M__a_r_y_M__a__d_d_e_n__-R__ic__h_a_r_d_s__#_W__-_3_/_K__Y_S_0__9_1__0_1__2_4_________________ Photo ID: ____R_IM__G_0__0_5_6_____Time: ____1_:4__5_p__m__ Lat (N): _____3__7_.7__0_6_8__9_1______ Long (W) _____-_8_6__.7_1__6_3_8________ Description: i_n_j_e_c_t_io_n__w__e_l_l_i_s_c_o__v_e_r_e_d__in__c_r_u__d_e__o_i_l _-_d_o_e__s_n__o_t_h__a_v_e__a_n__i_n_je__c_t_io_n__l_in__e_,_i_s_d__is_c__o_n_n_e__c_t_e_d______ UIC Inspector UIC Inspector Name:_______C_a__ro__l _C_h__e_n____________________________ Name: ______________________________________________ Signature: _C__A__R__O__L___C__H__E__N__D_a_te_: _20_2_4._03_.2_7_1_6:_44_:4_7_-_04_'0_0_' ____ Signature: ___________________________________________ Digitally signed by CAROL CHEN Version 2018-04-18