Document G6kNQL317Q1kn80N4N0KrxGQ7

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#: F L S 1 1 3 0 0 5 0 Year-Month-Day: 2 0 2 2 - 0 9 - 1 3 EPA Permit # (or RA): 1 1 0 7 Page 1 Of 2 Inspector(s): Page Cirillo ___________________ (lead), Jason Rose_____________________________ Start Time: 7:20 AM ____ ____________________________________, ____________________________________ End Time: 7:32 AM_____ Facility Contact Information Facility Name: Blackjack Plant ____________________________________________________________________________ Street Address: 4940 Blackjack Plant Road ___________________________________________________________________ City: Jay ____________________________ County: Santa Rosa _____________________ State: FL _____ Zip:32535 ___ Nature of Business: Oil and gas production __________________________________________________________________ Facility Owner/Operator: Black Creek Energy, LLC ____________________________ Phone: (601) 431-5386 __________ Email: harris.butler@butlerroyals.com ______________________________________________________________________ Facility Contact (if different): Michael Wetzel ___________________________________ Phone: (805) 324-6271 __________ O/O Mailing Address: 140 Virginia Street, Suite 402 __________________________________________________________ City: Richmond ______________________ County: NA_____________________________ State: VA _____ Zip: 23209 ___ Well Data from File Well Name & #: Black Jack Creek SWDS #1-3 Well Type (see table): Disposal _______________________________________ State Permit: API # 0911320225 _________ Latitude (N): 30.848162 N_______________ Longitude (W): -87.118922W____________Elevation (ft):193.9' (RKB) _ Injection Method (check applicable): Casing Injector; Tubing & Packer; Cemented Injection Tubing PBTD 6953' (w/ bit.) Other: __________________________________________________________________ Total Depth (ft): 7003' _____ Inner Casing Size (in):7" ______ Tubing Size (in):4.5" ______ Packer Depth (ft): 6157'___ Inj. Zone: Open Hole; Perforated; Top(ft): 6311' __ Bottom(ft):6900' ______ Max. Injection Pressure (psig):1,800 psi Field Measurements and Observations Latitude (N): 30.848178 N_______________Longitude (W): -87.118932W Elevation (ft): NA EPA GPS ID: PG No. 3358766066 ________ Well Status (see table):SI If not Active, Reported Date Last Active: Operator did not provide. Nature of Injected Fluid(s) if any: __________________________________________________________________________ General Condition of the Well Site: _____________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): DEP indicated the disposal well is used as needed depending on when the plant is down. The operator confirmed this statement. The observed internal pressure was 0 psi. Disposal well did not appear to be operating at the time of inspection. The site was clean and well-maintained. There was no evidence of leaks or excessive corrosion. Perfs (see well schematics): 3/22/1988 6311-388' DIL; 6410-6420' DIL 9/23/1983 6452-6672' DIL _1_2_/_2_1_/_1_9_8__3_6_7__9_6_-6__9_0_0_'_D_IL_____________________________________________________________________________ _____________________________________________________________________________________________________ See reverse for additional observations, comments and photo log Owner/Operator Representative (Optional) UIC Inspector Name: Cliff Emmons ___________________________________ Name: Page Cirillo ____________________________________ Signature & Date: see attached field notes ________________ Signature & Date: 10/07/2022 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 5 0 Year-Month-Day: 2 0 2 2 - 0 9 - 1 3 EPA Permit # (or RA): 1 1 0 7 Page 2 Of 2 (Cont) ________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Photographer: Jason Rose ____________________________EPA Camera ID: PG camera ID no. 14 S/N:31029537 _______ Photo ID:1________________Time: 7:14 AM ____ Lat (N): NA___________________ Long (W): NA _________________ Description: Looking south, Black Jack Creek SWDS #1-3 sign alongside access road. ______________________________ Photo ID:2________________Time: 7:17 AM ____ Lat (N): NA___________________ Long (W): NA _________________ Description: Looking south, site overview, including well head, pressure gauges, valves, and access stairs. __________ Photo ID:3________________Time: 7:18 AM ____ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking south, closeup view of surface and production casing pressure gauges reading 0 psi. _____________ Photo ID:4________________Time: 7:22 AM ____ Lat (N): NA __________________ Long (W): NA ___________________ Description: Looking south, closeup view of internal pressure gauge reading 0 psi. _________________________________ Photo Log Owner/Operator Representative (Optional) UIC Inspector Name: Cliff Emmons ___________________________________ Name: Page Cirillo ____________________________________ Signature & Date: see attached field notes ________________ Signature & Date: 10/07/2022 Version 2018-04-18 Site Photographs Blackjack Creek SWDS #1-3: September 13, 2022 Photograph 1: Looking south, Blackjack Creek SWDS #1-3 sign alongside access road. Page 1 of 4 Photograph 2: Looking south, site overview, including well head, pressure gauges, valves, and access stairs. Page 2 of 4 Photograph 3: Looking south, closeup view of surface casing pressure gauge (0 psi) and production casing pressure gauge (0 Psi). Page 3 of 4 Photograph 4: Looking west, closeup view of internal pressure gauge reading 0 psi. Page 4 of 4