Document Ra2LNezDzqMOQ5gkGJ1NYXv48
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
Inspector(s):
Carol Chen
_ (lead), ,
EPA Well ID#: F L S Year-Month-Day: 2 0 2
EPA Permit # (or RA):
Carla Foy
1 1 30 4 -05 F L I 0
Page 1
Start Time:
End Time:
05 5 - 0 1 0 2 9 Of 2
2:05 pm
2:07 pm
Facility Contact Information
Facility Name: Street Address: City:
Black Creek Energy, LLC
4940 Blackjack Plant Rd.
Jay
County:
Santa Rosa
Nature of Business:
Oil and gas production
Facility Owner/Operator: Email:
Harris D. Butler, III harris.butler@butlerroyals.com
Facility Contact (if different):
O/O Mailing Address: 140 Virginia Street, Suite 302
City:
Richmond
County:
N/A
State: FL
Zip:32565-9260
Phone: (804)-334-0527
Phone:
State: VA Zip: 23219
Well Data from File
Well Name & #: St. Regis Paper Company (SRPC) #13-3
Well Type (see table):
Enhanced Oil Recovery (EOR)
Latitude (N):
30.85450534
Longitude (W):
API No. 0911320041 PA No. 302383
State Permit:
-87.10260216
OG_ 523
Elevation (ft):
Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing
PBTD: 16143'
Other: srfc csg 10" @ 4242'
Otis WB packer at 15550'
Total Depth (ft): 16235' Inner Casing Size (in):
Tubing Size (in):
Otis WB 15477'
Packer Depth (ft):
Inj. Zone: Open Hole; X Perforated; Top(ft) 15732' Bottom(ft): 15823' Max. Injection Pressure (psig): 2500 psi
Latitude (N): No GPS 000
Longitude (W): No GPS 000
Elevation (ft):
EPA GPS ID: SX8123 Well Status (see table): TA If not Active, Reported Date Last Active: 8/24/17
Nature of Injected Fluid(s) if any:
General Condition of the Well Site:
Field Measurements and Observations
Notes & Comments (include discrepancies from database values):
This well is inactive.
Tubing gauge: Production gauge: Surface gauge:
0 psi 0 psi 0 psi
See reverse for additional observations, comments and photo log
U IC Inspector
UIC Inspector
Name:
Carol Chen
Name:
Signature: CAROL CHEN
Digitally signed by CAROL CHEN Date: 2024.06.24 11:08:27 -04'00'
Signature:
UIC Inspector:
UIC Inspector:
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)
St. Regis Paper Company (SRPC) #13-3
EPA Well ID#: F L S 1 1 3 0 0 5 5 Year-Month-Day: 2 0 2 4 - 0 5 - 0 1
EPA Permit # (or RA): F L I 0 0 2 9 Page 2 Of 2
Field Measurements and Observations (Cont.)
Photo Log
Photographer:
Carol Chen
EPA Camera ID:
Photo ID: DSCN1450 Time: 2:07 pm Lat (N): No GPS 000
Description: well identification sign at property entrance Photo ID: DSCN1451 Time: 2:08 pm Lat (N): No GPS 000
Description: injection well Photo ID: DSCN1452 Time: 2:08 pm
Lat (N):
No GPS 000
Description: surface gauge reads 0 psi
Photo ID: DSCN1453 Time: 2:08 pm Lat (N): No GPS 000
Description: production gauge reads o psi
Photo ID: DSCN1454 Time: 2:08 pm Lat (N): No GPS 000
Description: tubing gauge reads 0 psi
Photo ID:
Time:
Lat (N):
Description:
Name:
U IC Inspector)
Carol Chen
Name:
Signature: CAROL CHEN
Digitally signed by CAROL CHEN Date: 2024.06.24 11:08:50 -04'00'
Signature:
SC8284
Long (W)
No GPS 000
Long (W) No GPS 000
Long (W) No GPS 000
Long (W) No GPS 000
Long (W) No GPS 000
Long (W)
UIC Inspector
Version 2018-04-18
UIC Inspector:
UIC Inspector: