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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 1 2 0 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_:_1_4__p__m__ ____________________________________, ____________________________________ End Time: _1_:_2_1__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__-_5________________________________________________________ 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_3_9__2_4_________ Longitude (W): ______-8__6_.7__1_7_9__4_9________ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing Other: __________________________________________________________________ Total Depth (ft): __2_6_6__' ____ Inner Casing Size (in): ___5_"____ Tubing Size (in):___2_"______ Packer Depth (ft): ________ Inj. Zone: Open Hole; Perforated; Top(ft) ________ Bottom(ft): ___________ Max. Injection Pressure (psig): __2_1__0___ Field Measurements and Observations Latitude (N): _____3_7_._7_0__3_9_6_3____________ Longitude (W): _______-8__6_.7__1_7_9__8_0_0______ Elevation (ft): ____________ - EPA GPS ID: _S__7_5__3_3_2_ Well Status (see table): ___A__B____ If not Active, Reported Date Last Active: ___4_/_2__1_/_2_0__1_5_____ 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_l_ls__#_W__-_2__a_n_d__W__-_3__a_r_e__n_o_t_a__u_t_h_o_r_i_z_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_i_s__w_e_l_l_i_s_d__is_c__o_n_n_e__c_t_e_d__fr_o_m___t_h_e__w__h_it_e__p_o_l_y_v_i_n_y_l_c_h__lo_r_i_d_e__(_P_V_C__) _i_n_je__c_ti_o_n__l_in__e_,_s_e_v__e_r_a_l _f_e_e_t__a_w_a__y_. ___ _T_h_e__re__a__re__n_o__g_a__u_g_e_s__p_r_e_s_e__n_t_t_o__a_s_s_e__s_s_t_h_e__w__e_l_l'_s_i_n_t_e_r_n_a_l__c_a_s_i_n_g__p_r_e_s_s_u_r_e_.__It__is__a_p_p__a_r_e_n_t__th__a_t________ _c_r_u_d__e_o__il_s_p__u_r_t_e_d__a_ll__a_r_o_u_n_d__t_h_e__i_n_j_e_c_t_io_n__w__e_l_l,_l_e_a_v__in_g__i_t_c_o_v_e__re__d__in__a__b_l_a_c_k_e__n_e_d__o_i_ly__s_u_b__s_ta__n_c_e_,______ __w_h_i_c_h__a_l_s_o__s_p_r_e_a_d__t_h_i_c_k_l_y_a_c__ro__s_s_t_h_e__g_r_o_u__n_d__s_u_r_f_a_c_e__a_n__d_v__e_g_e_t_a_t_io__n__to__a__d_i_s_t_a_n_c_e__o_f__7__fe__e_t_. _________ See reverse for additional observations, comments and photo log 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_.0_3_.2_7_1_6_:4_1_:1_9_-0_4_'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 EPA Well ID#: K Y S 0 9 1 0 1 2 0 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__-_5_______________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Photo Log Photographer:_________B__ri_a_n_n_a__L_a_P__a_p_a_____________ EPA Camera ID: _________S_7_5__3_3_2_______________________ Photo ID: __R__IM__G__0_0_4_3______Time: __1_:_1_6__p_m____ Lat (N): ___3__7_._7_0_4_2__5_________ Long (W) _____-_8_6_._7_1_6__5_0_3_______ Description: __p_h__o_t_o_o__f_i_n_s_p_e__c_ti_o_n__r_e_p_o__r_t _______________________________________________________________ Photo ID: ___R_I_M__G_0_0__4_4_____Time: __1__:1__6_p__m___ Lat (N): ____3_7_._7_0__3_9_5_5________ Long (W) _____-8__6_._7_1_7_9__7_7_______ both the injection well and ground surface, show evidence of crude oil spewing Description: ___________________________________________________________________________________________ Photo ID: ___R__IM__G__0_0_4_5_____Time: ___1_:1__7__p_m___ Lat (N): ____3_7__.7_0__3_9_6__3_______ Long (W) _____-_8_6_._7_1_7__9_8_0__0_____ Description: __i_n_je__c_t_io_n__w__e_l_l _c_l_o_s_e_-_u_p____________________________________________________________________ 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 UIC Inspector Name:_______C_a__ro__l _C_h__e_n____________________________ Name: ______________________________________________ CAROL CHEN Digitally signed by CAROL CHEN Date: 2024.03.27 16:41:44 -04'00' Signature: ___________________________________________ Signature: ___________________________________________ Version 2018-04-18