Document Jrd8pqG272jJrDYjwo0RgpkKZ
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): Carl E. Weller
_ (lead),
,
EPA Well ID#: F L S 1 1 3 0 0 1 6
Year-Month-Day: 2 0 2 3 - 0 3 - 3 0
EPA Permit # (or RA): N O N E
Page 1 Of 2
Carol Chen
Start Time:12:50 pm
End Time: 1:05 pm
Facility Contact Information
Facility Name: Maverick Natural Resources, LLC (Breitburn Operating LP)
Street Address: 5415 Oil Plant Rd
City: Jay
County: Santa Rosa
State: FL Zip: 32565
Nature of Business: oil and gas production
Facility Owner/Operator: Maverick Natural Resources, LLC
Phone: 850-675-1702
Email:
Facility Contact (if different): Al Jones, Plant Superintendent
O/O Mailing Address: 5415 Oil Plant Rd
City:
Jay
County: Santa Rosa
Phone: 251-227-3319 State: FL Zip: 32565
Well Data from File
Well Name & #: C. H. Bray Et Ux #10-1A
API No. 0911320039 PA No. 311587
Well Type (see table): Enhanced Oil Recovery (EOR)
State Permit:
OG_521
Latitude (N):
30.96306703
Longitude (W):
-87.15891826 Elevation (fOt):tis WB @15265'
Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing Otis WB @15205'
PBTD: 15737'
Other:
surface casing 10" @3716' Superior Permapak Packer @15140'
Total Depth (ft): 15753' Inner Casing Size (in):
Tubing Size (in):
Upper Globe Perm Packer @ 15097'
Packer Depth (ft):
Inj. Zone: Open Hole; X Perforated; Top(ft) 15408' Bottom(ft): 15680'
4400 psi PW Max. Injection Pressure (psig):
Field Measurements and Observations
Latitude (N):
30.96312
Longitude (W):
-87.15895
Elevation (ft):
EPA GPS ID: SX8123 Well Status (see table): AC If not Active, Reported Date Last Active:
Nature of Injected Fluid(s) if any: Produced fluids
General Condition of the Well Site: Added notes & comments: Maximum Injection pressures are Nitrogen (N) 7500 psi, Produced Water (PW) 4400 psi
Notes & Comments (include discrepancies from database values): T-disk was installed on the nitrogen (N) flowline, blocking
Perforations (Smackover Formation):
gas injection. The produced waters flowline to the injection
15408' to 15428' 5/09/1974
well was open for injection.
15419' to 15448' 11/24/2014
Tubing gauge:
400 psi
15482' to 15542' 1/25/1973 15590' to 15610' 5/03/1972
Production gauge Surface gauge:
0 psi 0 psi
15620' to 15680' 11/24/2014
Well passed mechanical integrity test on 5/12/2022.
Name: Signature:
See reverse for additional observations, comments and photo log
UIC Inspector
UIC Inspector
Carl E. Weller
Digitally signed by CARL WELLER
CARL WELLER (Affiliate) (Affiliate)
Date: 2023.05.23 15:06:47 -04'00'
Name:
Carol Chen
CAROL CHEN Digitally signed by CAROL CHEN Date: 2023.05.17 07:13:23 -04'00'
Signature:
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)
EPA Well ID#: F L S 1 1 3 0 0 1 6 Year-Month-Day: 2 0 2 3 - 0 3 - 3 0
EPA Permit # (or RA): N O N E
Page 2 Of 2
Field Measurements and Observations (Cont.)
Photo Log
Photographer: Photo ID: Description: Photo ID: Description:
Carl E. Weller
EPA Camera ID:
SX8123
204
Time: 12:57 pm Lat (N): 30.96312
Long (W)
sign posted directly on the injection well, close-up photo
205
Time: 12:59 pm Lat (N):
injection well, several feet away
30.96311
Long (W)
-87.15895 -87.15891
Photo ID:
Time:
Lat (N):
Long (W)
Description:
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
Name: Signature:
Carl E. Weller
Digitally signed by CARL WELLER
CARL WELLER (Affiliate) (Affiliate)
Date: 2023.05.23 15:07:16 -04'00'
UIC Inspector
Name: Carol Chen
CAROL CHEN Digitally signed by CAROL CHEN Date: 2023.05.17 07:13:55 -04'00'
Signature:
Version 2018-04-18