Document KzbGkz15vNV02qE9kV0k8VJX6
Inspection ID
Facility Contact Information
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 Year-Month-Day: 2 0 2
EPA Permit # (or RA):
Carol Chen
1 1 30 0 07 3 -03 - 28 NO N E
Page 1 Of 2
Start Time: 10:29 am End Time: 10:40 am
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:
Black Creek Energy, LLC
Email:
Mike Wetzel <mikew2859@gmail.com>
Facility Contact (if different):
Michael Wetzel
O/O Mailing Address: 140 Virginia Street, Suite 302
City:
Richmond
County:
N/A
State: FL
Zip:32565-9260
Phone: 601-431-5386 Phone: 850-324-6271
State: VA Zip: 23219
Well Name & #: St. Regis Paper Company (SRPC) #12-3
Well Type (see table):
Enhanced Oil Recovery (EOR)
Latitude (N):
30.86788333
Longitude (W):
API No. 0911320072 PA No. 303045
State Permit:
-87.10358333
OG_ 581
Elevation (ft):
Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing
PBTD: 16124' Total Depth (ft): 16410'
Other: srfc csg 10" @3990'
Inner Casing Size (in):
Tubing Size (in):
Otis WB 15810'
Packer Depth (ft):
Inj. Zone: Open Hole; X Perforated; Top(ft) 15976' Bottom(ft): 16066' Max. Injection Pressure (psig): 2500 psi
Latitude (N): 30.86792
Longitude (W): -87.10364
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:
Well Data from File
Field Measurements and Observations
Notes & Comments (include discrepancies from database values):
Tubing gauge: Production gauge: Surface gauge:
1450 psi
0 psi 0 psi
Injection well passed a mechanical integrity test
Name: Signature:
See reverse for additional observations, comments and photo log
U IC Inspector
UIC Inspector
Carl E. Weller
Digitally signed by CARL WELLER
CARL WELLER (Affiliate) (Affiliate)
Date: 2023.05.11 13:22:21 -04'00'
Name: Carol Chen
Signature: CAROL CHEN Date: 2023.05.10 19:07:40 -04'00' Digitally signed by CAROL CHEN
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 0 7 Year-Month-Day: 2 0 2 3 - 0 3 - 2 8
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:
141
Time: 10:31 am Lat (N): 30.86761
sign posted
142
Time: 10:34 am Lat (N): 30.86792
photo of injection well
SX8123 Long (W) -87.10349
Long (W) -87.10364
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: Carl E. Weller
CARL WELLER (Affiliate) Signature:
Digitally signed by CARL WELLER (Affiliate) Date: 2023.05.11 13:22:58 -04'00'
UIC Inspector
Name: Carol Chen
Signature: CAROL CHEN Date: 2023.05.10 19:08:12 -04'00' Digitally signed by CAROL CHEN
Version 2018-04-18