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IL. PROG
NOTICE OF INSPECTION
UNITED STATESENVIRONMENTAL PROTECTION AGENCY REGION 8, 1595 Wynkoop Street DENVER, Co 80202-1129 Phone 800-227-8917 http://www.epa.gov/region8
Notice of inspection is hereby ven accordng to Section 1445(b) of the Safe
Drinking Water Act (42 U.S.C. 300f et seq.) Hour:
Firm Name: MtOL clA -A4'1
Firm Address:_ It Z\ 2 () t)\5
...
J/A51 4 7
REASON FOR INSPECTiON:
For the purpose of inspecting records, flies, papers, processes, controls and
facilities, and obtaining samples to determine whether the person subject to an applicable underground injection control program has acted or is acting in
compliance wIth the Safe Drinking Water Act and any applicable contion of perrntt or rule authorization.
SECTION 1445(b) of the SAFE DR1NRING WATER ACT is quoted below:
Section 1445(b)(i): Except as provided in Paragraph (2),
the Admini,strator, or' representatives of the Administrator
duly designated by him, upon presenting appropriate
credentials, and a written notice to. any supplier of water
or other person subject to. (a), or person subject (A) a national primary drinking water regulation prescribed under Section 14 12(B) an applicable Underground Injection Control Program, or (C) any requirement to monitor an unregulated contaminant pursuant to subsection (a), or person in charge of any of the property of such supplier or other person referred to in clause (A), (B), or (C), is authorized to enter any establishment, ... facility, or other property of such supplier or other person in order to determine whether such supplier or other person has acted or is acting in compliance with this title, including for this purpose,
inspection, at reasonable times, of records, files, papers, processes, controls, and facilities, or in order to test any feature of a public water system, including its raw water source. The Administrator or the Comptroller General (oi: any representative designated by either) shall have thcess f or the purpose of audit and examination to any records, reports, or information of a grantee which are required to be maintained under subsection (a) or which are pertinent to any financial assistance under this title.
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inspectors Name & Title, (Print)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
rnspec1
Signature
EPA RB 56O-i (8-89)
Origlnel - Reginal Office Copy Yet lo4 Copy - Oprtor Copy
Inspector(s):
Inspection Form UT22222-09434 - Middle Fork Energy Uinta, LLC; GH 8G-17-8-21
U.S. Environmental Protection Agency, Region 8
Gary Wanc
Underground Injection Control Program
Operator Representative:
Tribal Representative:
ott
Date: 7/ 1~I23
Time: It): ,C
J)pm
_ _ _ _ _ _ _ _ _ _ _ _ _
Well Type Well Status, Date API No. Oilfield Name Latitude / Longitude Indian Country Permit Issued
Enhanced Recovery (2R)
WELL INFORMATION _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Prior Inspecon 06/20/2017
Temporarily Abandoned, 11/01/2016 Last MIT (I)
SAPT, 2 Yrs, 09/04/2021
43-047-37992 Gypsum Hills
Last MIT (II) MAIPI, Date
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
1615
psi,
04/12/2013
40.12599 / -109.57154
MAIP2, Date
Uintah & Ouray
Cum Vol Limit
05/15/2012
,Routine
U Emergency
0 Other:
INSPECTION TYPE: D Construction/Rework
U MIT Witness
U Complaint U Closure/P&A
WELL STATUS:
U Under Construction
U Active
pIremporary Abandon
DP&A'ed
0Other:
_ _ _ _ _ _ _ _ _ _
Injection Tubing
WELLHEAD PRESSURES If Dual injector, observe & record as (U)pper and (L)ower injection zones
Operator Gauge: oDigital / oAnalog EPA Gauge: oDigital / oAnalog Comments
Range: 0 3000
ID & Range:O
Pressure (psi): i.. 7
Pressure (psi):E
b Annulus
Operator Gauge: Range: 0 -t)tZ Pressure (psi):
Digital / oAnalog
EPA Gauge: oDigital / oAnalog ID& Range: Pressure (psi):
Comments
iJQ
Operator Gauge: oDigital / oAnalog Bradenhead Range:
Annulus Pressure (psi):
EPA Gauge: oDigital / oAnalog ID & Range: Pressure (psi):
Comments
ili) -
_ _ _ _ _ _ _ _ _ _ _
Injection Rate
INJECTION RATES & VOLUMES
If Dual injector, observe & record as( U)pper and (L)ower injection zones
1BPD I DCFM
Comments
o
Is this the lifetime cumulative volume? DYes I DNo Cumulative
Injection EIBL / DMCF
Comments
Volume
Shut-off Device
Device(s) Present: U SCADA (Digital) / flMurphy Switch (Analog) / DPhysical Pop-off Valve
Shutoff Setting (psi)
Comments ojr c) (
C \3 7k( CA).
DCN R8FQPForm -2023
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Inspection Form UT22222-09434 - Middle Fork Energy Uinta, LLC; GH 8G-17-8-21
Photos Taken? DYes / No
PHOTOLOGS If Yes, provide Photo Log Addendum
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Lowest USDW
_ _ _ _ _ _ _ _ _ _ _ _ _ _
Upper Confining Zone Injection Zone
GEOLOGY (ft KB)
Name
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Top
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Bottom
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Conductor Csg:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Interm Csg 1: Interm Csg 2: Prod Csg:
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Liner:
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Tubing:
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Pen Interval: Packer Depth:
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CONSTRUCTION (ft KB) Top
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Bottom
ADDITIONAL COMMENTS Appx B - RTS required on all AOR wells once every
5 years
C'- L-4
Insped(or Signatue
DCN R8FQPForm -2023
LAWRENCE
Digitally signed by LAWRENCE
GRANATO (Affiliate)
GRANATO (Affiliate) Date: 2023.07.28 07:10:41 -06'00'
Inspector Signature
Inspector Signature
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