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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 1 5 3 0 1 6 9 Year-Month-Day: 2 0 2 4 - 1 0 - 2 2 EPA Permit # (or RA): R A Phone: (404)562-9424 Page 1 Of 2 Inspector(s): _C_a__ro__l _C_h_e__n______________________ (lead),_____L_o_n__n_ie__D_o_r_n___________________ Start Time: _9_:_4_0__a__m__ ____________________________________, ____________________________________ End Time: 9__:_4_4__a__m__ Facility Contact Information Facility Name:___S__l_o_n_e__E__n_e_r_g__y_,_L_L__C____________________________________________________________________ Street Address:__8_9__6_6__K__Y__R__T__4_0__W__e__s_t_, _P_._O__._B__o_x__2_2__0_,__K__Y__4_1_2__3_8______________________________________ City: _O__il_S__p_r_in_g_s____________________ County:______M__a_g_o_f_f_in__________________ State:__K_Y_____ Zip: 41238 Nature of Business: ___o__il_p__r_o_d_u__c_ti_o_n_____________________________________________________________________ Facility Owner/Operator: _____M__r.__S_.__C_h__ri_s__S_l_o_n__e_,_P__E______________________ Phone: _6_0__6_._2_9__7_._5_3__3_0__w__o__r_k__ Email: ________c_h__ri_s_s_lo__n_e_@__s_l_o_n_e_e__n_e_r_g_y_._c_o_m_____________________________________________________________ Facility Contact (if different): ________________________________________________ Phone: _6_0__6__.2__2_5__._2_2__0_6___c_e__ll__ O/O Mailing Address: ____________________________________________________________________________________ City: _______________________________ County: _______________________________ State:________ Zip: _________ Well Data from File Well Name & #: _____R__.__L_.__S_A__L__Y_E__R__S__-__J_I_M___A_R__N__E__T__T__#_W___-_1_________________________________________ Well Type (see table): _C__la_s__s_I_I_-_R_,__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_5_1__8___________ Longitude (W): ______-_8_3__.0__1_6_0_8_________ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; XTubing & Packer; Cemented Injection Tubing Other: __4_____"_p__r_o_d__u_c__t_io__n__c__a_s_i_n__g_____________________________________ Total Depth (ft): __________ Inner Casing Size (in): _2_____"__ Tubing Size (in):____1_"_____ Packer Depth (ft): ________ Inj. Zone: Open Hole; Perforated; Top(ft) ________ Bottom(ft): ___________ Max. Injection Pressure (psig): ________ Field Measurements and Observations Latitude (N): _____0__0_0__________________ Longitude (W): ______0__0_0_______________ Elevation (ft): ____________ EPA GPS ID: _S_7__5_3__3_2_ Well Status (see table): ___T__A____ If not Active, Reported Date Last Active: _1__/2__7__/_2_0__1__5_____ Nature of Injected Fluid(s) if any: __________________________________________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): ______________________________________________________ _____________________________________________________________________________________________________ _T__h_e__d__i_s_c_o__n_n__e__c_t_e_d___in__je__c_t_i_o_n___p_i_p_i_n_g___is___n_e__a_r_b__y__a_n__d__a__p_p__e_a__r_s__h__e_a__v_i_ly__c__o_r_r_o__d_e__d_.__________ _T__h_e__w__e__l_lc__a_p__a__l_s_o__s__h_o__w__s__c_o__r_r_o_s__io__n_.___________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ See reverse for additional observations, comments and photo log 8,&,QVSHFWRU UIC Inspector Carol Chen Name:______________________________________________ Name: ______________________________________________ Signature: _C_A__R__O__L__C_H__E__N_______D_a_te_: _20_2_4._12_.1_1_1_3:_49_:1_9_-0_5_'00_' ___ 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 Phone: (404)562-9424 EPA Well ID#: K Y S 1 5 3 0 1 Year-Month-Day: 2 0 2 4 - 1 0 - EPA Permit # (or RA): R A Page 2 Of 69 22 2 (Cont) ________________________________________________________________________________________________ ____________R__._L__._S__A__L__Y_E__R__S___-__J_I_M___A__R__N__E__T_T___#_W___-_1_____________________________________________ _____________________________________________________________________________________________________ ___________C__la__s_s___II_-_R__,__E_n__h_a__n__c_e__d__O__i_l _R__e__c_o_v__e_r_y___(E__O__R__)________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Photo Log Photographer:_____C__a_r_o_l__C_h__e_n______________________EPA Camera ID: ___S__7_5__3_3__2___________________________ Photo ID: _R__IM___G__0_1_8__3_____Time: _9_:_4_4___a_m____ Lat (N): ____0_0__0______________ Long (W) ___0_0__0________________ Description: __v_i_e_w___o__f_t_h_e___in__j_e_c_t_i_o_n___w__e_l_l____________________________________________________________ Photo ID: _R__IM__G__0_1__8_4______Time: _9_:_4_4__a__m____ Lat (N): ____0_0__0______________ Long (W) ___0__0_0________________ Description: _c_l_o_s_e__-_u_p__v__ie__w__, _a_t__a__s_l_ig__h_t__a_n__g_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: ___________________________________________________________________________________________ Photo ID: _________________Time: ____________ Lat (N): _____________________ Long (W) ______________________ Description: ___________________________________________________________________________________________ 8,&,QVSHFWRU UIC Inspector Carol Chen Name:______________________________________________ Name: ______________________________________________ Signature: _C_A__R__O_L__C__H__E_N________D_a_te_: 2_0_24_.1_2_.1_1 1_3_:4_9:_42_-_05_'0_0'____ Signature: ___________________________________________ Digitally signed by CAROL CHEN Version 2018-04-18