Document Lgk2Ka8jVM05aMekjZRk92vQ3

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 1 1 3 0 0 0 8 Year-Month-Day: 2 0 2 4 - 0 5 - 0 1 EPA Permit # (or RA): Page 1 Of 2 Carla Foy Start Time: 1:34 pm End Time: 1:38 pm Facility Contact Information Facility Name: Street Address: City: Black Creek Energy, LLC 4940 Blackjack Plant Rd. Jay County: Nature of Business: Oil and gas production Facility Owner/Operator: Harris D. Butler, III Email: harris.butler@butlerroyals.com Santa Rosa 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 & #: W. W. Foskett #24-3 Well Type (see table): Enhanced Oil Recovery (EOR) Latitude (N): 30.84115384 Longitude (W): API No. 0911320097 PA No. 303048 State Permit: -87.10155299 OG_623 Elevation (ft): Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing PBTD: 15991' Total Depth (ft): 16030' Other: srfc csg 9" @4090' Otis WB paker set at 15700' Baker Hornet Full Bore Paker set at Inner Casing Size (in): Tubing Size (in): Packer Depth (ft): 15620' Inj. Zone: Open Hole; X Perforated; Top(ft) 15865' Bottom(ft): 15935' 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): SI If not Active, Reported Date Last Active: 9/11/23 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 property entrance, DANGER sign: HS May Be Present This well is inactive, shut-in, with some Tubing gauge: pressure on gauges. Production gauge: Surface gauge: 100 psi 50 psi 50 psi Name: See reverse for additional observations, comments and photo log U IC Inspector UIC Inspector Carol Chen Name: Signature: CAROL CHEN Digitally signed by CAROL CHEN Date: 2024.06.24 10:46:15 -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) W. W. Foskett #24-3 EPA Well ID#: F L S 1 1 3 0 0 0 8 Year-Month-Day: 2 0 2 4 - 0 5 - 0 1 EPA Permit # (or RA): Page 2 Of 2 Field Measurements and Observations (Cont.) Photo Log Photographer: Carol Chen EPA Camera ID: SC8284 Photo ID: DSCN1436 Time: 1:37 pm Lat (N): No GPS 000 Long (W) No GPS 000 Description: well identification sign and DANGER sign: HS May Be Present, at property entrance Photo ID: DSCN1437 Time: 1:38 pm Lat (N): No GPS 000 Long (W) No GPS 000 Description: injection well Photo ID: DSCN1438 Time: 1:38 pm Lat (N): Long (W) Description: tubing gauge reads 100 psi Photo ID: DSCN1439 Time: 1:39 pm Lat (N): Description: production gauge reads 50 psi Long (W) Photo ID: DSCN1440 Time: 1:39 pm Lat (N): Long (W) Description: surface gauge reads 50 psi Photo ID: Time: Lat (N): Long (W) Description: U IC Inspector) UIC Inspector Name: Carol Chen Name: Signature: CAROL CHEN Digitally signed by CAROL CHEN Date: 2024.06.24 10:46:41 -04'00' Signature: Version 2018-04-18 UIC Inspector: UIC Inspector: