Document OJ1eE50MrMG3E2267ZJ15XB5X
Inspection ID
Facility Contact Information
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): Carl E. Weller
_ (lead),
,
EPA Well ID#: F L S 1 1 3 0 0 3 8
Year-Month-Day: 2 0 2 3 - 0 3 - 2 9 EPA Permit # (or RA): N O N E
Page 1 Of 2
Carol Chen
Start Time: 12:57 pm
End Time: 1:06 pm
Facility Name: Maverick Natural Resources, LLC (Breitburn Operating LP)
Street Address: 5415 Oil Plant Rd
City: Jay
County: Santa Rosa
State: FL Zip: 32565
Nature of Business: oil and gas production
Facility Owner/Operator: Maverick Natural Resources, LLC
Phone: 850-675-1702
Email:
Facility Contact (if different): Al Jones, Plant Superintendent
O/O Mailing Address: 5415 Oil Plant Rd
City:
Jay
County: Santa Rosa
Phone: 251-227-3319 State: FL Zip: 32565
Well Name & #: Well Type (see table): Latitude (N):
J. E. Jackson #40-4A
Enhanced Oil Recovery (EOR)
30.95984573
Longitude (W):
API No. 0911320100 PA No. 311598
State Permit:
-87.20001232
OG_627
Elevation (ft):
Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing
PBTD: 15778'
Other:
surface casing 9" @3744'
BHA Otis WB Packer
Total Depth (ft): 15828' Inner Casing Size (in):
Tubing Size (in):
Packer Depth (ft): 15510'
Inj. Zone: Open Hole; X Perforated; Top(ft) 15656' Bottom(ft): 15710'
4400 psi PW Max. Injection Pressure (psig)7: 500 psi N
Latitude (N):
30.95986
Longitude (W):
-87.20005
Elevation (ft):
EPA GPS ID: SX8123 Well Status (see table): TA If not Active, Reported Date Last Active: 1/29/2020
Nature of Injected Fluid(s) if any:
General Condition of the Well Site:
Well Data from File
Field Measurements and Observations
Notes & Comments (include discrepancies from database values):
Maximum injection pressure: 7500 psi Nitrogen (N), 4400 psi Produced waters (PW).
Injection well failed a mechanical integrity test on 1/29/2020. Valves are shut, sealed. Needs workover.
Perforations (Smackover Formation): 15656' to 15666' (4SPF) 1/15/1974 15656' to 15666' (4SPF) 10/28/2012
Tubing gauge: Production gauge Surface gauge:
5250 psi 0 psi
0 psi
15700' to 15710' (4SPF) 5/01/1974
15700' to 15710' (4SPF) 10/28/2012
See reverse for additional observations, comments and photo log
UIC Inspector
UIC Inspector
Name: Signature:
Carl E. Weller
Digitally signed by CARL WELLER
CARL WELLER (Affiliate) (Affiliate)
Date: 2023.05.17 10:14:41 -04'00'
Name:
Carol Chen
CAROL CHEN Date: 2023.05.15 15:37:57 -04'00' Digitally signed by CAROL CHEN
Signature:
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)
EPA Well ID#: F L S 1 1 3 0 0 3 8 Year-Month-Day: 2 0 2 3 - 0 3 - 2 9
EPA Permit # (or RA): N O N E
Page 2 Of 2
Field Measurements and Observations (Cont.)
Photo Log
Photographer: Photo ID: Description: Photo ID: Description:
Carl E. Weller
EPA Camera ID:
SX8123
178
Time: 12:57 pm Lat (N): 30.95986
Long (W)
sign posted directly on the injection well, closest GPS location
179
Time: 12:58 pm Lat (N): 30.95987
Long (W)
photo of injection well, a few feet back
-87.20005 -87.20001
Photo ID:
Time:
Lat (N):
Long (W)
Description:
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
Name: Signature:
Carl E. Weller
Digitally signed by CARL WELLER
CARL WELLER (Affiliate) (Affiliate)
Date: 2023.05.17 10:15:07 -04'00'
UIC Inspector
Name: Carol Chen
CAROL CHEN Date: 2023.05.15 15:38:32 -04'00' Digitally signed by CAROL CHEN
Signature:
Version 2018-04-18