Document RJmvywX7jEQRbg5NJk9rxQ7Bv

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 Year-Month-Day: 2 0 2 4 - 0 4 - EPA Permit # (or RA): Page 1 Of 1 6 3 0 2 Inspector(s): ___C_a__rl__E_._W__e_l_le__r_________________ (lead),____C__a_r_o_l_G__._C_h__e_n_________________ Start Time: _4_:_5_1__p__m__ ____________________________________, ____________________________________ End Time: _5_:_0_3__p__m__ Facility Contact Information Facility Name:__M__a_v_e_r_i_c_k__N_a_t_u_r_a__l _R_e_s__o_u_r_c_e_s_,__L_L_C_____(_B_r_e_i_tb__u_r_n__O_p__e_r_a_t_in_g__L_P__)___________________________ Street Address:_5__4_1__5__O_i_l _P_l_a_n_t__R_d_______________________________________________________________________ City: _____J_a_y________________________ County: ___S__a_n_t_a__R_o__s_a_________________ State:___F_L____ Zip: _3__2_5__6_5__ Nature of Business: _____o_i_l _a_n_d__g_a__s_p__ro__d_u_c_t_i_o_n___________________________________________________________ Facility Owner/Operator: _M__a_v_e__r_ic_k__N__a_t_u_r_a_l_R__e_s_o_u__rc_e__s_,_L_L_C________________ Phone: _8__5_0__-6__7_5_-_1_7__0_2_________ Email: ________________________________________________________________________________________________ Facility Contact (if different): __A_l__J_o_n_e_s_,__P_l_a_n_t__S_u_p_e__r_in_t_e_n__d_e_n__t _______________ Phone: __2_5_1__-2__2_7__-3__3_1_9_________ O/O Mailing Address: ___5_4__1_5__O__il_P__la__n_t_R__d________________________________________________________________ City: ______J_a_y_______________________ County: ____S__a_n_t_a__R_o__s_a________________ State:__F_L_____ Zip: __3_2__5_6_5__ Well Data from File Well Name & #: ___C_._H__. _B_r_a_y__E_t__U_x__#_1__0_-_1_A______________A_P_I_N__o_.__0_9__1_1_3__2_0__0_3_9____________P_A__N_o__. _3_1__1_5__8_7___ Well Type (see table): ____E_n_h__a_n_c_e__d__O_i_l _R_e__c_o_v_e_r_y__(E__O_R__)_____________ State Permit: ___O__G____5_2_1________________ Latitude (N): ______3_0__.9__4_4_1__7_5__________ Longitude (W): ______-8__7_._1_5__2_1_5__5_______ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing PBTD: 15,737' Upper Smackover 5 sets of performations Other: ___s_u_r_f_a_c_e__c_a_s_i_n_g__1__0__3_/_4_"__t_o_3__,7__1_6__' ______________________________ Total Depth (ft): 1__5_,_7_5_3__' __ Inner Casing Size (in): _7__"_1_5_,7_5_3' Tubing Size (in):_3__1__/_2_"___ Packer Depth (ft): _1_5__,0__9_7_' Inj. Zone: Open Hole; XPerforated; Top(ft) _1_5_,_4_0__8_ Bottom(ft): _1_5__,6_8__0_' ___ Max. Injection Pressure (psig): 7,500 psi N2 gas 4_,4_0_0_p_s_i_P_W ' Latitude (N): ____N__o__G_P__S__0_0_0___________ Longitude (W): _____N_o__G__P_S__0_0__0________ Elevation (ft): ____________ EPA GPS ID: __S_C_8__2_8__4 Well Status (see table): ___A__C____ If not Active, Reported Date Last Active: __________________ Nature of Injected Fluid(s) if any: _____N_i_t_r_o_g_e_n__(_N__)__G_a__s_I_n_j_e_c_t_io__n___________________________________________ Field Measurements and Observations General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): ______________________________________________________ DANGER sign: HS May Be Present...Hazardous Operations...Keep Out...Authorized Personnel Only... _____________________________________________________________________________________________________ _T_h_i_s_w__e_l_l_i_s_a__c_ti_v_e_l_y_i_n_j_e_c_t_in__g_N__i_tr_o_g_e__n__(N___)_G__a_s_._________T_u_b_i_n_g__g_a_u__g_e_:___________5__0_0__0__p_s_i____________ ___"__T_-_S_k_i_ll_e_t_o__n__th__e_g__re__e_n__c_a_s_i_n_g__o_f__th__e_P__r_o_d_u_c__e_d_______P_r_o_d_u__c_ti_o_n__g_a__u_g_e_:_______0__p_s__i ________________ _W__a_t_e_r_s__(_P_W__)_F__lo_w___L_in__e_i_s__to__b__lo_c__k_t_h_a__t_i_n_je__c_t_io_n_________S_u__rf_a_c__e_g__a_u_g_e__: _________0__p_s_i_________________ _a__n_d__t_o_p__r_o_t_e_c_t_a__g_a_i_n_s_t_c_o__rr_o__s_io_n__. ______________________F_l_o_w__L_i_n_e__g_a_u__g_e_:_____________________________ _____________________________________________________________________________________________________ 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._06_.2_0_2_1:_24_:3_1_-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 Phone: (404)562-9424 EPA Well ID#: F L S 1 1 3 0 0 1 6 Year-Month-Day: 2 0 2 4 - 0 4 - 3 0 EPA Permit # (or RA): Page 2 Of 2 (Cont) ________________________________________________________________________________________________ ______C__H__B_r_a_y__E_t__U_x__#_1_0__-1__A__________________________________________________________________________ _____________________________________________________________________________________________________ _P_e_r_f_o_r_a_t_io__n_s__(S__m__a_c_k_o_v_e__r_F_o_r_m__a_t_i_o_n_)_:________________________________________________________________ _1_5__4_0_8__' _to__1__5_4_2__8_'_5__/_0_9__/_1_9_7__4_______________________________________________________________________ 1__5_4__1_9_'_t_o__1_5__4_4__8_'_1_1__/_2_4__/_2_0__1_4______________________________________________________________________ _1_5__4_8__2_'_t_o__1_5_5__4_2__' _1_/_2__5_/_1_9__7_3_______________________________________________________________________ 1__5_5__9_0_'_t_o__1_5__6_1__0_'_5_/__0_3_/_1__9_7__2_______________________________________________________________________ _1_5_6__2_0__' _to__1__5_6_8__0_'_1__1_/_2_4__/_2_0__1_4______________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Photo ID: DSCN1365 Time: 5:03 pm Lat (N): No GPS 000 Long (W): No GPS 000 _____________________________________________________________________________________________________ _D_e_s_c_r_i_p_t_io_n_:___p_h_o_t_o__s_h_o__w_i_n_g__t_h_e__M__a_n_i_f_o_ld__o__f _t_h_e__P_r_o_d__u_c_e_d__W__a_t_e_r_s__(_P_W__)_F_l_o_w__L__in_e__, _w__it_h__a__fl_o_w__-l_in__e____ _g__a_u_g_e__t_h_a_t__r_e_a_d_s__0__p_s__i._N__o__in__je_c__ti_o_n__i_s_o__c_c_u_r_r_in__g_f_r_o_m___th__e__p_r_o_d_u__c_e_d__w_a__te__rs__f_lo__w__li_n_e__. _______________ 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_3__5_9____Time: __4_:_5_6__p__m___ Lat (N): ____N_o__G__P_S__0_0__0______ Long (W) ____N_o__G__P_S__0_0__0_______ Description: _i_n_j_e_c_t_io__n__w_e_l_l_i_d_e_n__ti_f_ic_a__ti_o_n__s_i_g_n__a_t_t_h_e__f_r_o_n_t__o_f_t_h_e__p_r_o__p_e_r_t_y_______________________________ Photo ID: ___D__S_C__N_1__3_6_0____Time: __4_:_5_7__p__m___ Lat (N): ____N__o_G__P_S__0__0_0______ Long (W) ____N_o__G__P_S__0__0_0_______ injection well, well identification sign, DANGER sign: HS May Be Present...Hazardous Operations... Description: ___________________________________________________________________________________________ Photo ID: ___D__S_C__N_1__3_6_1____Time: __4_:_5_8__p_m____ Lat (N): ____N__o_G__P_S__0__0_0______ Long (W) ____N__o_G__P_S__0__0_0_______ Description: _s_u__rf_a_c_e__g_a__u_g_e__r_e_a_d__s_0__p__s_i________________________________________________________________ Photo ID: ___D__S_C__N_1__3_6_2____Time: __4_:_5_8__p__m___ Lat (N): ____N__o_G__P_S__0__0_0______ Long (W) ____N__o_G__P_S__0__0_0_______ Description: _p_r_o__d_u_c_t_i_o_n__g_a_u_g__e_r_e__a_d_s__0__p_s_i_____________________________________________________________ Photo ID: ___D__S_C_N__1_3__6_3____Time: _4__:5__8__p_m____ Lat (N): ____N_o__G__P_S__0_0__0______ Long (W) ____N__o__G_P__S__0_0__0______ Description: ___"__T_-_S_k_i_ll_e_t__o_n__t_h_e__g_r_e_e_n__c_a_s__in_g__P__ro__d_u_c_e__d__W_a__te__r_s_(_P_W__)__F_lo__w__L_i_n_e_________________________ Photo ID: ___D_S__C_N__1_3__6_4____Time: __5__:0__0__p_m___ Lat (N): ____N_o__G__P_S__0_0__0______ Long (W) ____N__o__G_P__S_0__0_0_______ Description: __tu__b_i_n_g__g_a_u_g__e_r_e_a__d_s__5_0__0_0__p_s_i_____________________________________________________________ UIC Inspector Name:_____________________________________________ UIC Inspector Carol Chen Name: ______________________________________________ Signature: ___________________________________________ CAROL CHEN Digitally signed by CAROL CHEN Signature: ______________________D_a_te_: _20_2_4._06_.2_0_2_1:_24_:5_8_-0_4_'0_0'___ Version 2018-04-18