Document M4Z7rBB9YeMx1nLBOMa7Ln0r9

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 3 1 0 1 1 7 Year-Month-Day: 2 0 2 4 - 1 0 - 2 3 EPA Permit # (or RA): K Y I 0 4 2 9 Phone: (404)562-9424 Page 1 Of 2 Inspector(s): ____C_a_r_o_l_C__h_e_n____________________ (lead),_____L_o_n_n__ie__D__o_r_n__________________ Start Time: _5_:_3_0___p_m__ ____________________________________, ____________________________________ End Time: _6_:_0_0___p_m__ Facility Contact Information Facility Name:_____R__e_a_l_A__ll_o_y__R_e_c_y__c_li_n_g_,_L_L__C_____________________________________________________________ Street Address:____8_0_5__G__a_r_n_d_e_r__L_a_n_e_____________________________________________________________________ City: ___M__o_r_g_a__n_to__w_n_________________ County: ____B__u_tl_e_r______________________ State:__K_Y_____ Zip: _4_2__2_6__1__ Nature of Business: __I_n_d_u_s_t_r_ia_l_-__U_s_e__d__B_e_v_e_r_a_g__e_C__a_n__R__e_c_y_c_l_in_g__O__p_e_r_a_t_io_n__________________________________ Facility Owner/Operator: ____R__e_a_l_A__ll_o_y__R_e_c_y__c_li_n_g_,_L_L__C_____________________ Phone: _2_7_0__.5_2__6_.0__5_0_5___________ Email: ______A_n_d__y_.J_e__n_n_i_n_g_s_@__r_e_a_l_a_l_lo_y_._c_o_m_______________________________________________________________ Facility Contact (if different): _____A_n__d_y_M__._J__e_n_n_i_n_g_s___________________________ Phone: _2_1_6__-7_5__5_-_8_8_4_0___________ O/O Mailing Address: _____________________________________________________________(m__:_2__1_6_-_8_1_6_-_4_4__7_8_)______ City: _______________________________ County: _______________________________ State:________ Zip: _________ Well Data from File Well Name & #: ____IM___C__O___#__1__________________________________________________________________________ Well Type (see table): _C__la_s__s_I__(_N_o__n_h_a__z_a_r_d_o__u_s__In__d_u_s__tr_i_a_l)___________ State Permit: __________________________ Latitude (N): ____3_7_._2_0_6_9__2_8_____________ Longitude (W): _____-_8_6_._7_1_7_1__3_3_________ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; Tubing & Packer; Cemented Injection Tubing Other: _7_"_i_n_t_e_r_m__e_d_ia__te__c_a_s__in_g_____________________________________________ 4" production liner Total Depth (ft): __________ Inner Casing Size (in): ________ Tubing Size (in):_2____"__3___" Packer Depth (ft): ________ Inj. Zone: Open Hole; Perforated; Top(ft) ________ Bottom(ft): ___________ Max. Injection Pressure (psig): _2_7__0_0___ Field Measurements and Observations Latitude (N): _____0__0_0__________________ Longitude (W): _____0__0_0________________ Elevation (ft): ____________ EPA GPS ID: S__C__8_2_8__4_ Well Status (see table): _________ If not Active, Reported Date Last Active: __________________ Nature of Injected Fluid(s) if any: l_e_a__c_h_a__t_e_:_o__n_s__it_e__r_e_s__id__u_a_l__w__a_s_t_e__l_a_n__d_f_il_l_a__n_d__s__to__r_m__w__a__te__r_d__r_a_i_n_a__g_e__ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): _s_e_c__o_n_d__a_r_y__s_m__e_l_ti_n_g__&__a__ll_o_y_i_n_g__o_f__a_l_u_m__in__u_m__________ _____________________________________________________________________________________________________ _O__n_s__it_e__i_n_j_e_c_t_i_o_n__p__r_e_s_s__u_r_e__(_p_s__ig__):___7_7_6__._6_________________________________________________________ _a_n__n_u_l_u_s__p_r_e_s__s_u_r_e__(_p_s_i_g_)_:_6_._4________________________________________________________________________ _L_a_s__t_m__e_c_h__a_n_i_c_a_l__in__te__g_r_it_y__d_e_m__o__n_s_t_r_a_t_io_n__:__J_a_n__u_a_r_y__2_2__, _2_0_2__4_______________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ See reverse for additional observations, comments and photo log UIC Inspector UIC Inspector Name:___C__a_r_o__l_C__h_e__n_______________________________ Name: ______________________________________________ Signature: _C_A__R__O__L__C__H_E__N_______D_a_te_: _20_2_4._12_.1_2_1_8:_17_:5_0_-0_5_'0_0'___ 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 0 3 1 0 1 1 7 Year-Month-Day: 2 0 2 4 - 1 0 - 2 3 EPA Permit # (or RA): K Y I 0 4 2 9 Page 2 Of 2 (Cont) ________________________________________________________________________________________________ _____________________________________________________________________________________________________ ______I_M__C__O____#_1____________C_l_a_s_s__I_(_N__o_n__h_a_z_a__r_d_o_u__s_I_n_d__u_s_t_r_ia__l)_______________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _D_e_s_c_ri_p_ti_o_n_: ___________________________________________________________________________________________ _P_h_ot_o_I_D_: _D__S__C_N__1__4_8__4___T_im__e_:_n__o__n_e________L_a_t_(_N_)_:__0__0__0________L_o_n_g__(_W__) ___0__0__0_________________________ _D_e_s_c_ri_p_ti_o_n_: __P__V__C__b__r_a_i_d_e_d___h_o_s__e_____________________________________________________________________ _P_h_o_to_I_D_:_D__S__C__N__1_4__8_5___T_i_m_e_:_n__o__n_e________L_a_t_(_N__):__0__0__0________L_o_n_g__(_W__)___0_0__0__________________________ _D_e_s_c_ri_p_ti_o_n_: __d__ra__in_____________________________________________________________________________________ _P_h_o_to_I_D_:__D__S__C_N__1__4_8__6__T__im_e_:__n_o__n__e_______L_a_t_(_N__):___0_0__0________L_o_n_g__(_W__) __0__0__0__________________________ _D_e_s_c_ri_p_ti_o_n_: __t_a_n_k__s__w__it_h__p_r_e__s_s_u__r_e__g_a__u_g__e_s___________________________________________________________ _P_h_o_to_I_D_:___D__S_C__N__1_4__8_7___T_im__e_: _n__o_n__e_______L_a_t_(_N__):___0_0__0________L_o_n_g__(_W__):__0__0__0__________________________ _D_e_s_c_ri_p_ti_o_n_: _____a_n_n__u_lu__s__p_r_e_s_s_u__r_e_g__a_u_g__e__fo__r_w__e_l_lh__e_a_d_________________________________________________ _P_h_o_t_o_I_D_:_D__S__C__N__1_4_8__8___T_im__e_: _n__o__n_e_______L_a_t_(__N_)_: __0__0__0_______L_o_n_g__(_W__):__0__0__0__________________________ _D_e_s_c_rip_t_io_n_: _____d_i_g_i_ta__l _r_e_a__d_e__rs__o__f_t_h_e___m__o_n__it_o_r_i_n_g__s__y_s_t_e_m_____________________________________________ Photo Log Photographer:____C__a__ro__l_C__h_e__n______________________EPA Camera ID: _____S_C__8__2_8__4_________________________ Photo ID: _D__S_C__N__1_4_8__9_____Time: _n_o__n__e______ Lat (N): __0__0__0_______________ Long (W) __0__0__0________________ Description: ____a_n_a__ly__z_e_r_s_/_d_a_t_a__r_e_c_o__rd__e_r_s______________________________________________________________ Photo ID: _D__S_C__N__1__4_9__0____Time: _n_o__n__e______ Lat (N): __0__0__0_______________ Long (W) __0__0_0_________________ Description: ______p_u__m__p__s__y_s_t_e__m_______________________________________________________________________ Photo ID: _D__S_C__N__1_4_9__1_____Time: _n__o_n__e______ Lat (N): __0__0__0_______________ Long (W) __0__0__0________________ Description: ______a_n__a_l_y_z_e__r_s_,_e__q_u__ip__m__e_n__t_s_e__t_u_p_______________________________________________________ Photo ID: _D__S__C__N__1_4_9__2____Time: _n__o_n__e______ Lat (N): __0__0__0_______________ Long (W) __0__0__0________________ Description: __i_n__je__c__ti_o__n__w__e__l_l________________________________________________________________________ Photo ID: _D__S_C__N__1_4_9__3_____Time: _n__o_n__e______ Lat (N): ___0__0_0_______________ Long (W) __0__0__0________________ Description: __w__e__ll_h__e_a__d_,__t_u_b__in__g__g__a_u__g_e______________________________________________________________ Photo ID: _D__S_C__N__1__4_9__4____Time: _n__o_n__e______ Lat (N): ___0__0_0_______________ Long (W) __0__0__0________________ Description: _tu__b_i_n_g__g__a_u__g_e__, _a_n__o_t_h_e__r_a__n_g__le____________________________________________________________ UIC Inspector UIC Inspector Name:___C_a__r_o_l__C_h__e_n________________________________ Signature: _C__A__R___O__L___C__H__E___N__D_a_t_e:_2_0_24_.1_2_.1_2_1_8_:1_8:_1_8_-0_5_'0_0'_ Digitally signed by CAROL CHEN Name: ______________________________________________ Signature: ___________________________________________ Version 2018-04-18