Document YGVYpQ3Q9B4kdrq3kEqJVJ5MK

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 0 9 Year-Month-Day: 2 0 2 2 - 0 9 - 1 3 EPA Permit # (or RA): 6 7 8 Page 1 Of 2 Inspector(s): Jason Rose ___________________ (lead), Page Cirillo_____________________________ Start Time: 11:10 AM___ ____________________________________, ____________________________________ End Time: 11:20 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 & #: R. L. Moore #23-E Well Type (see table): Enhanced Recovery (EOR) ________________________ State Permit: API # 0911320121 _________ Latitude (N): 30.84106039 N ___________ Longitude (W): -87.1119759 W __________ Elevation (ft): NA _________ Injection Method (check applicable): Casing Injector; Tubing & Packer; Cemented Injection Tubing PBTD 16, 037' Other: __________________________________________________________________ Total Depth (ft): 16,070' ___ Inner Casing Size (in): 7" ______ Tubing Size (in): 2.875" ___ Packer Depth (ft): 15,774' Inj. Zone: Open Hole; Perforated; Top(ft): 15,928'_ Bottom(ft): 15,976' ____ Max. Injection Pressure (psig): 2,500 psi Latitude (N): 30.840995 N______________ Longitude (W): -87.112166 W ___________ Elevation (ft): NA _________ EPA GPS ID: PG No. 3358766066 Well Status (see table): TA If not Active, Reported Date Last Active: Operator did not provide. Nature of Injected Fluid(s) if any: __________________________________________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): ______________________________________________________ Field Measurements and Observations DEP indicated this well has been temporarily plugged and abandoned, meaning that it is no longer in use, and all perforations have been plugged with cement. The site was clean and well-maintained. There was no evidence of leaks or excessive corrosion. The stairway was unstable, in need of repairs/upgrades. Perfs (see well schematics): 8/20/1975 4SPF, 12/3/77 2SPF 15,928-15,940' GR 1_0_/_1_3_/_7_9__4_S_P_F__1_5_,_9_5_4_-_1_5_,9__7_6_'_G_R________________________________________________________________________ _____________________________________________________________________________________________________ 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 0 9 Year-Month-Day: 2 0 2 2 - 0 9 - 1 3 EPA Permit # (or RA): 6 7 8 Page 2 Of 2 (Cont) ________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Photo Log Photographer: Jason Rose ____________________________EPA Camera ID: PG camera ID no. 14 S/N:31029537 _______ Photo ID: 1 _______________Time: 11:11 AM ___ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking north, R.L. Moore #23-E sign alongside access road. ______________________________________ Photo ID: 2 _______________Time: 11:11 AM ___ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking north, site overview showing well head, pressure gauges, valves, and as stairway. ____________ Photo ID: 3 _______________Time: 11:12 AM ___ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking east, closeup view of surface pressure gauge reading 0 psi. ________________________________ Photo ID: 4 _______________Time: 11:12 AM ___ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking east, closeup view of production casing pressure gauge reading 0 psi._______________________ Photo ID: 5 _______________Time: 11:13 AM ___ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking west, closeup view of internal pressure gauge reading 0 psi. _______________________________ Photo ID: 6 _______________Time: 11:14 AM ___ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking south, access stairway with sagging platform. ___________________________________________ 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 R.L. Moore #23-E September 13, 2022 Photograph 1: Looking north, R.L. Moore #23-E sign alongside access road. Page 1 of 6 Photograph 2: Looking north, site overview showing well head, pressure gauges, valves, and access stairway. Page 2 of 6 Photograph 3: Looking east, closeup view of surface pressure gauge reading 0 psi. Page 3 of 6 Photograph 4: Looking east, closeup view of production casing pressure gauge reading 0 psi. Page 4 of 6 Photograph 5: Looking west, closeup view of internal pressure gauge reading 0 psi. Page 5 of 6 Photograph 6: Looking south, access stairway with sagging platform. Page 6 of 6