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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 Phone: (404)562-9424 EPA Well ID#: F L S 1 1 3 0 0 6 7 Year-Month-Day: 2 0 2 2 - 0 9 - 1 3 EPA Permit # (or RA): 6 9 3 Page 1 Of 2 Inspector(s): Jason Rose ___________________ (lead), Page Cirillo_____________________________ Start Time: 7:33 AM ____ ____________________________________, ____________________________________ End Time: 7:45 AM_____ Facility Contact Information Facility Name: Blackjack Plant ____________________________________________________________________________ Street Address: 4940 Blackjack Plant Road _________________________________________________________________ City: Jay ____________________________ County: Santa Rosa _____________________ State: FL _____ Zip:32535 ___ Nature of Business: Oil and gas production__________________________________________________________________ Facility Owner/Operator: Black Creek Energy, LLC ____________________________ Phone: (601) 431-5386 __________ Email: harris.butler@butlerroyals.com ______________________________________________________________________ Facility Contact (if different): Michael Wetzel ___________________________________ Phone: (850) 324-6271 __________ O/O Mailing Address: 140 Virginia Street, Suite 402 __________________________________________________________ City: Richmond ______________________ County: NA_____________________________ State: VA _____ Zip: 23209 ___ Well Data from File Well Name & #: J.H. Wells #23 Well Type (see table): Enhanced Recovery (EOR) ________________________ State Permit: API # 0911320130 _________ Latitude (N): 30.848734N______________ Longitude (W): -87.120376W ___________ Elevation (ft): NA _________ Injection Method (check applicable): Casing Injector; Tubing & Packer; Cemented Injection Tubing PBTD 15,980' Other: __________________________________________________________________ Total Depth (ft): 16,070' ___ Inner Casing Size (in): 7" ______ Tubing Size (in): 3.5"______ Packer Depth (ft): 15,740' _ Inj. Zone: Open Hole; Perforated; Top(ft): 15,912'_ Bottom(ft): 15,941' ____ Max. Injection Pressure (psig): 2,500 psi Field Measurements and Observations Latitude (N): 30.848739 N______________ Longitude (W): -87.120407W ___________ Elevation (ft): 207' _______ EPA GPS ID: PG No. 3358766066 Well Status (see table): TA If not Active, Reported Date Last Active: estimated 1990's Operator did not provide specific date._______________________________ Nature of Injected Fluid(s) if any: NA _______________________________________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): ______________________________________________________ The surface casing, production casing and internal pressure gauges read 0 psi. According to DEP's August 2022 inspection report, this well was temporarily plugged and abandoned on 07/28/2006.This means that all perforations to both the Smackover and Tuscaloosa formations have been cemented, but not up to the surface. For this well to be permanently plugged and abandoned, all casings would be cemented all the way up to the surface. The site was clean and well-maintained. There was no evidence of leaks or excessive corrosion. Perfs (see well schematics): 15912-941" GR _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ See reverse for additional observations, comments and photo log Owner/Operator Representative (Optional) UIC Inspector Name: Cliff Emmons ___________________________________ Name: Jason Rose ____________________________________ Signature & Date: see attached field notes ________________ Signature & Date:__________________________1_0_/_2_6_/_2_2____ 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#: F L S 1 1 3 0 0 6 7 Year-Month-Day: 2 0 2 2 - 0 9 - 1 3 EPA Permit # (or RA): 6 9 3 Page 2 Of 2 (Cont) ________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Photographer: Jason Rose ____________________________EPA Camera ID: PG camera ID no. 14 S/N:31029537 _______ Photo ID: 1 _______________Time: 7:32 AM ____ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking west, J.H. Wells #23 sign alongside access road.__________________________________________ Photo ID: 2 _______________Time: 7:36 AM ____ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking east, closeup view of surface casing pressure gauge (left, reading 0 psi) and production casing pressure gauge (right, reading 0 psi). _____________________________________________________________________ Photo ID: 3 _______________Time: 7:39 AM ____ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking northeast, closeup view of internal pressure gauge reading 0 psi.___________________________ Photo Log Owner/Operator Representative (Optional) UIC Inspector Name: Cliff Emmons ___________________________________ Name: Jason Rose ____________________________________ Signature & Date: see attached field notes ________________ Signature & Date:__________________________1_0_/_2_6__/2__2___ Version 2018-04-18 Site Photographs J.H. Wells #23 September 13, 2022 Photograph 1: Looking west, J.H. Wells #23 sign alongside access road. Photograph 2: Looking east, closeup view of surface casing pressure gauge (left, reading 0 psi) and production casing pressure gauge (right, reading 0 psi). Photograph 3: Looking northeast, closeup view of internal pressure gauge reading 0 psi.