Document X7z2eBZjKZ8k1ZbXjaYzL3k04

DownloadSearchable PDFRandom document
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 3 - 0 7 - 1 9 EPA Permit # (or RA): K Y A 0 3 6 2 Phone: (404)562-9424 Page 1 Of 2 Inspector(s): ____C__a_r_l_E_.__W__e_l_le_r________________ (lead),_____C__a_r_o_l_C__h_e_n___________________ Start Time: _1_1_:_5_5__a_m__ ____________________________________, ____________________________________ End Time: _1_2_:_0_9__a_m__ Facility Contact Information Well Data from File Field Measurements and Observations 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__ta__ti_o_n__D__r_iv_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_ti_o_n___________________________________________________________ Facility Owner/Operator: ____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_______ Phone: ____2__7_0__-9__2_6_-_1_6__8_9______ Email: ___________________G__le__n_n__R_i_d_g__e_s_:__2_7_0__-3__1_6__-7__4_8__7_______________________________________________ Facility Contact (if different): ____M_r_._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__ti_o_n__D__ri_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__ Mary Madden-Richards #W-5 Well Name & #: ________________________________________________________________________________________ Well Type (see table): ______E_n__h_a_n_c__e_d__O_i_l_R__e_c_o_v_e__ry__(_E_O__R_)___________ State Permit: __________________________ Latitude (N): ______3_7__.7__0_3_9__5___________ Longitude (W): _____-_8_6__.7__1_8__1__________ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing PBTD: Other: __________________________________________________________________ Total Depth (ft): __________ Inner Casing Size (in): ________ Tubing Size (in):__________ Packer Depth (ft): ________ Inj. Zone: Open Hole; Perforated; Top(ft) ________ Bottom(ft): ___________ Max. Injection Pressure (psig): ________ Latitude (N): _____3_7__.7__0_3_9__2_4___________ Longitude (W): _____-8__6_._7_1__7_9__4_9________ Elevation (ft): ____________ EPA GPS ID: _S_X__8_1_2__3_ 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: _________________________________________________________________________ _____________________________________________________________________________________________________ The Mary Madden-Richards wells are located in Notes & Comments (include discrepancies from database values): ______________________________________________________ _R_e_y_n_o_l_d_s_S_t_a_t_io_n_,_K__e_n_tu_c_k_y__4_2_3_6__8_. _A_t_t_h_e_#__W_-_5_w__e_ll_,_n_o_g__a_u_g_e_s_w__e_re__o_b_s_e_r_ve__d_. _A_t_t_h_e_t_im__e__o_f_th__e_ _o_f_t_h_e_i_n_s_p_e_c_t_io_n_,_t_h_e__a_re_a__a_r_o_u_n_d_t_h_e__w_e_l_lh_e_a_d__w_a_s__o_b_s_e_r_v_e_d_w__it_h_b_l_a_c_k_o_i_ly__m__a_te_r_ia__l/_p_r_o_d_u_c_e_d__o_il _a_l_o_n_g__th_e__g_r_o_u_n_d_a_n__d_v_e_g_e_t_a_ti_o_n__fo_r_a__ro_u_n_d__a__7_f_t_r_a_d_iu_s_.____________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ See reverse for additional observations, comments and photo log UIC Inspector UIC Inspector Carl E. Weller Name:______________________________________________ Name: _____C__a_r_o_l_C_h__e_n_______________________________ Digitally signed by CARL WELLER (Affiliate) Signature:_C_A_R__L_W__E_L_L_E__R_(_A_f_fi_li_a_te_)_D_a_te_: 2_02_3._09_.1_9 1_6_:14_:2_1_-0_4'0_0'______ Signature: _C_A__R__O__L__C__H_E__N_______D_a_te_: _20_2_3._09_.1_9_1_4:_52_:5_3_-0_4_'0_0'___ 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#: K Y S 0 9 1 0 1 2 0 Year-Month-Day: 2 0 2 3 - 0 7 - 1 9 EPA Permit # (or RA): K Y A 0 3 6 2 Page 2 Of 2 (Cont) ___M__a_r_y__M__a_d_d__e_n_-_R_i_c_h_a__rd__s_#__W__-_5________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Photo Log Photographer: _____C__a_r_l _E_._W___e_ll_e_r____________________EPA Camera ID: SX8123 ______________________________________ Photo ID: _____2_3_4__________Time: __1_0_:_3_5__a__m__ Lat (N): ____3_7__.7__0_7__8_1_2_______ Long (W) _____-8__6_._7_1_9__4_3__9______ Description: ___________o_p_e__ra__to__r_'s__s_ig__n__o_n__t_h_e__p_r_o_p_e__rt_y__________________________________________________ Photo ID: ____2__3_5__________Time: _1__0_:_3_5__a_m___ Lat (N): ____3__7_._7_0_7__8_0__9______ Long (W) _____-8__6_._7_1_9__4_4__8______ Description: ___________t_a_n__k__b_a_t_t_e_r_y_a__n_d__o_p_e__r_a_t_o_r_'s__s_i_g_n________________________________________________ Photo ID: _____2_5__6_________Time: _1_1__:5__4__a_m___ Lat (N): ____3__7_._7_0__3_9__2_4______ Long (W) ____-_8_6__.7__1_7_9__4_9_______ close-up of injection well, coated with black oily material, produced fluids Description: ___________________________________________________________________________________________ Photo ID: _____2_5__7_________Time: _1_1_:_5_5__a_m____ Lat (N): ____3__7_._7_0__3_9__3_9______ Long (W) ____-_8_6__.7__1_8__0_1__4______ farther back from the injection well, splatter of oily produced fluids Description: ___________________________________________________________________________________________ Photo ID: _________________Time: ____________ Lat (N): _____________________ Long (W) ______________________ Description: ___________________________________________________________________________________________ Photo ID: _________________Time: ____________ Lat (N): _____________________ Long (W) ______________________ Description: ___________________________________________________________________________________________ UIC Inspector UIC Inspector Carl E. Weller Name:______________________________________________ Name: ______C__a_r_o_l_C__h_e_n______________________________ Signature: _C_A_R__L_W__E_L_L_E_R__(_A_f_fil_ia_t_e_)_D_a_te_: 2_02_3._09_.1_9_16_:1_4:_51_-0_4_'00_' _____ Digitally signed by CARL WELLER (Affiliate) Signature: _C_A__R__O_L__C__H__E_N________D_a_te_: 2_0_23_.0_9_.19_1_4_:5_3:_21_-0_4_'0_0'____ Digitally signed by CAROL CHEN Version 2018-04-18