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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 0 9 1 0 2 1 6 Year-Month-Day: 2 0 2 4 - 0 2 - 2 1 EPA Permit # (or RA): K Y A 0 3 6 2 Phone: (404)562-9424 Page 1 Of 2 Inspector(s): _______C_a__r_o_l_C_h__e_n________________ (lead),______B__r_ia_n__n_a__L_a_P__a_p_a_____________ Start Time: _1_:_2_7__p_m___ ____________________________________, ____________________________________ End Time: _1_:_3_4__p_m___ Facility Contact Information Facility Name:______W__e__s_t_K__e_n_t_u_c_k__y_E_n__e_r_g_y__R_e_s_o__u_r_c_e_s_,_L__L_C______________________________________________ Street Address:______3_8_3__0__V_i_n_c_e_n__t_S_t_a_t_i_o_n__D_r_i_v_e_________________________________________________________ City: ____O__w_e_n__s_b_o_r_o_________________ County: ______H_a_n__c_o_c_k__________________ State:___K_Y____ Zip: _4__2_3__0_3__ Nature of Business: ________O__il__a_n_d__g_a__s_e__x_tr_a_c_t_i_o_n________________________________________________________ Facility Owner/Operator: ____W__e_s_t__K_e_n__tu__c_k_y__E_n_e__rg__y_R__e_s_o_u__rc_e__s_,_L_L_C________ Phone: ____2__7_0_-_9__2_6_-_1_6__8_9______ Email: ______________G__le__n_R__i_d_g_e_s_:__2_7_0__-3__1_6__-7__4_8_7_______________________________________________________ Facility Contact (if different): _____V__in__c_e_n_t__B_._H__a_y_d_e__n_,_J_r_.,__M__a_n_a_g__e_r___________ Phone: ____2__7_0_-_6__8_3_-_3_0__5_7______ O/O Mailing Address: __________3_8_3__0__V_i_n_c_e_n__t_S_t_a_t_i_o_n__D_r_i_v_e________________________________________________ City: _____O__w_e__n_s_b_o__ro________________ County: ______H_a_n__c_o_c_k__________________ State:___K_Y____ Zip: __4_2_3__0_3__ Well Data from File Well Name & #: ____M__a_r_y_M__a__d_d_e_n__-R__ic_h__a_r_d_s__#_W__-_4________________________________________________________ Well Type (see table): ______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__4_6__5__________ Longitude (W): _____-8__6_._7_1__9_2__5_9________ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing Other: __________________________________________________________________ Total Depth (ft): __2__3_0_'____ Inner Casing Size (in): ___5_"____ Tubing Size (in):___1___"____ Packer Depth (ft): ________ Inj. Zone: Open Hole; Perforated; Top(ft) ________ Bottom(ft): ___________ Max. Injection Pressure (psig): __2_1_5____ Field Measurements and Observations Latitude (N): ______3__7_.7__0_5_5_5__2__________ Longitude (W): _____-8__6_.7__1_9_0__2_8_________ Elevation (ft): ____________ EPA GPS ID: _S_7_5__3_3_2__ Well Status (see table): ___A_B_____ If not Active, Reported Date Last Active: __2__/_1_3_/_2__0_1_3______ Nature of Injected Fluid(s) if any: __________________________________________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): __T_h__e_M__a_r_y__M__a_d_d__e_n_-_R_i_c_h_a__rd__s_l_e_a_s__e_i_s_l_o_c_a__te__d__in_______ __R_e_y_n__o_l_d_s__S_t_a_t_io_n__,_K_e__n_t_u_c_k_y_,__4_2_3__6_8__. _______________________________________________________________ _W__e_ll_s__#_W__-_2__a_n_d__W__-_3__a_r_e_n__o_t_a__u_t_h_o_r_iz_e__d__b_y_P__e_r_m__it__N_o_.__K_Y_A__0_3_6__2_._O__n_l_y_W__-_1_,_W__-_4_,__W_-_5_,__W__-6__a_n__d__W__-7__. __ _T_h__e_i_n_je_c__ti_o_n__li_n_e_a__n_d_t_u_b_i_n_g__a_r_e_b_o__th__m__a_d_e__o_f_w_h__it_e_P__o_ly_v_i_n_y_l _C_h_l_o_r_id_e__(_P_V_C_)_t_u_b_i_n_g__a_n_d__a_r_e_d_i_s_c_o_n_n_e__c_te_d_.____ _N_o__g_a_u_g_e_s__a_r_e_f_o_u_n__d_. _A_n_n_u_l_u_s__c_a_s_in_g__p_r_e_s_s_u_r_e_n__e_e_d_s__to__b_e__re_g_u__la_r_ly__m__e_a_s_u_r_e_d__a_n_d__re_c_o_r_d_e_d__t_o_s_p__o_t__________ _p_o_t_e_n_t_ia__l _p_ro__b_le_m__s_._T_h_e_r_e__is__a__s_tr_e_a_m__n__e_a_r_b_y_, _1_5__fe_e__t _fr_o_m___th_e__in__je_c_t_io__n_w__e_ll_. _T_h_is__w_e__ll_i_s_a_t_t_h_e__e_d_g_e__o_f_a_______ _c_o_r_n_f_ie__ld_,_u_n__d_e_r_t_r_e_e_c_o_v_e_r_.____________________________________________________________________________ See reverse for additional observations, comments and photo log UIC Inspector UIC Inspector Name:_______C_a__ro__l _C_h__e_n______________________________ Name:______________________________________________ CAROL CHEN Digitally signed by CAROL CHEN Date: 2024.03.27 16:45:31 -04'00' Signature: ___________________________________________ Signature:___________________________________________ 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 EPA Well ID#: K Y S 0 9 1 0 2 1 6 Year-Month-Day: 2 0 2 4 - 0 2 - 2 1 EPA Permit # (or RA): K Y A 0 3 6 2 Phone: (404)562-9424 Page 2 Of 2 (Cont) ____M__a_r_y_M__a__d_d_e__n_-R__ic__h_a_r_d_s__#_W__-_4________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Photo Log Photographer:__________B_r_ia_n__n_a__L_a_P_a_p_a____________ EPA Camera ID: ______7__5_3_3__2__________________________ Photo ID: ___R__IM__G__0_0_4_6_____Time: __1__:2__9_p__m___ Lat (N): ____3_7_._7_0_3__9_6_________ Long (W) ____-_8_6_._7_1__7_8_4_9________ Description: __p_h__o_t_o__o_f_i_n_s_p_e__c_t_io_n__r_e_p__o_r_t_______________________________________________________________ Photo ID: ____R_I_M__G_0_0__4_7____Time: __1__:3__0_p__m___ Lat (N): ____3_7__.7_0__3_9_6_________ Long (W) ____-_8_6_._7_1__7_8_4_9________ Description: __p__h_o_t_o__o_f_i_n_j_e_c_t_io__n__w_e_l_l_, _s_e_e_n__f_a_r_t_h_e_r__b_a_c_k_________________________________________________ Photo ID: ___R__IM__G__0_0_4_8_____ Time: 1:30pm ____________ Lat (N): ____3_7__.7__0_5_5_9__5_______ Long (W) ____-_8_6_._7_1__9_0_2_2________ Description: c_l_o_s_e_-_u_p__o_f__in__je_c_t_i_o_n__w__e_ll_,_s_h__o_w_s__c_a_s__in_g__c_o__rr_o_s__io_n__, _w_h__it_e__P_V__C__tu__b_in__g________________________ Photo ID: ____R_I_M_G__0_0_4__9____Time: ___1_:3__3__p_m___ Lat (N): ____3__7_.7__0_5_5__5_2_______ Long (W) ____-_8_6_._7_1_9__0_2_8________ Description: _c_l_o_s__e_-_u__p__p__h_o__t _o__s_h__o_w__s__P__V__C__i_n_j_e__c_t_i_o__n__l_i_n_e___i s___n_o__t__s_c_r__e_w__e_d___o_n__t_o__t_h__e__t_u__b_i_n__g__ Photo ID: ____R_I_M__G_0_0__5_0____Time: ___1_:_3_3__p_m___ Lat (N): ____3__7_.7__0_5_5__6_8_______ Long (W) ____-_8_6__.7_1__9_0_2__5_______ Description: ___________________________________________________________________________________________ Photo ID: _________________ Time: ____________ Lat (N): _____________________ Long (W) ______________________ Description: ___________________________________________________________________________________________ UIC Inspector UIC Inspector Name:_______C_a__ro__l _C_h__e_n____________________________ Name: ______________________________________________ Signature: _C__A__R__O___L___C__H__E__N___D_a_t_e:_2_0_24_._03_.2_7_1_6_:4_5_:5_8_-_04_'0_0_' Signature: ___________________________________________ Digitally signed by CAROL CHEN Version 2018-04-18