Document JN1D4x6qkRdJpopr9dxz4vvOe
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
Inspector(s):
Carol Chen
_ (lead), ,
EPA Well ID#: F L S Year-Month-Day: 2 0 2
EPA Permit # (or RA):
Carla Foy
1 1 30 00 9 4 -05 -01
FL I0036
Page 1 Of 2
Start Time: 1:25 pm End Time: 1:31 pm
Facility Contact Information
Facility Name: Street Address: City:
Black Creek Energy, LLC
4940 Blackjack Plant Rd.
Jay
County:
Santa Rosa
Nature of Business:
Oil and gas production
Facility Owner/Operator:
Harris D. Butler, III
Email:
harris.butler@butlerroyals.com
Facility Contact (if different):
O/O Mailing Address: 140 Virginia Street, Suite 302
City:
Richmond
County:
N/A
State: FL
Zip:32565-9260
Phone: (804)-334-0527
Phone:
State: VA
Zip: 23219
Well Data from File
Well Name & #:
R. L. Moore #23-E
Well Type (see table):
Enhanced Oil Recovery (EOR)
Latitude (N): 30.84106039
Longitude (W):
API No. 0911320121 PA No. 303041
State Permit:
-87.119759
OG_ 678
Elevation (ft):
Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing
PBTD: 16037'
Other: srfc csg 9" @3895'
Total Depth (ft): 16070' Inner Casing Size (in):
Tubing Size (in):
Packer Depth (ft): 15103'
Inj. Zone: Open Hole; X Perforated; Top(ft) 15928' Bottom(ft): 15976' Max. Injection Pressure (psig): 2500 psi
Latitude (N): No GPS 000
Longitude (W): No GPS 000
Elevation (ft):
EPA GPS ID: SX8123 Well Status (see table): PA If not Active, Reported Date Last Active:
Nature of Injected Fluid(s) if any:
General Condition of the Well Site:
Field Measurements and Observations
Notes & Comments (include discrepancies from database values): At entrance, DANGER sign: HS May Be Present This well has a rig over it, presently undergoing plugging and abandonment operations.
FLI0036 permit was not issued.
Tubing gauge:
Production gauge:
Surface gauge:
Name:
See reverse for additional observations, comments and photo log
U IC Inspector
Carol Chen
Name:
UIC Inspector
Signature: CAROL CHEN
Digitally signed by CAROL CHEN Date: 2024.06.24 10:52:12 -04'00'
Signature:
UIC Inspector:
UIC Inspector:
Version 2018-04-18
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
(Cont)
R. L. Moore #23-E
EPA Well ID#: F L S 1 1 3 0 0 0 9 Year-Month-Day: 2 0 2 4 - 0 5 - 0 1
EPA Permit # (or RA): F L I 0 0 3 6
Page 2 Of 2
Field Measurements and Observations (Cont.)
Photo Log
Photographer:
Carol Chen
EPA Camera ID:
SC8284
Photo ID: DSCN1433 Time: 1:28 pm Lat (N): No GPS 000 Long (W) No GPS 000
Description: well identification sign, DANGER sign: HS May Be Present, at property entrance
Photo ID: DSCN1434 Time: 1:28 pm Lat (N): No GPS 000 Long (W) No GPS 000
Description: view of rig over the injection well in process of plugging and abandonment procedures
Photo ID: DSCN1435 Time: 1:29 pm Lat (N): No GPS 000
Long (W) No GPS 000
Description: slightly closer view of rig, although at specified distance to keep back for safety
Photo ID:
Time:
Lat (N):
Long (W)
Description:
Photo ID:
Time:
Lat (N):
Long (W)
Description:
Photo ID:
Time:
Lat (N):
Long (W)
Description:
Name:
U IC Inspector)
Carol Chen
Name:
UIC Inspector
Signature: CAROL CHEN
Digitally signed by CAROL CHEN Date: 2024.06.24 10:52:38 -04'00'
Signature:
Version 2018-04-18
UIC Inspector:
UIC Inspector: