Document YjkzgnmNa4d1pNGy8GY88pGjn

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 6 Year-Month-Day: 2 0 2 2 - 0 9 - 1 3 EPA Permit # (or RA): 6 8 6 Page 1 Of 2 Inspector(s): Jason Rose ___________________ (lead), Page Cirillo_____________________________ Start Time: 7:55 AM ____ ____________________________________, ____________________________________ End Time: 8:12 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 & #: Curtis B. Lowery #10-E Well Type (see table): Enhanced Recovery (EOR) ________________________ State Permit: API # 0911320125 _________ Latitude (N): 30.870125N______________ Longitude (W): -87.12829W ____________ Elevation (ft): NA _________ Injection Method (check applicable): Casing Injector; Tubing & Packer; Cemented Injection Tubing PBTD 15,930' Other: __________________________________________________________________ Total Depth (ft): 16,025' ___ Inner Casing Size (in): 7" ______ Tubing Size (in): 2.75" ____ Packer Depth (ft): 15,650' _ Inj. Zone: Open Hole; Perforated; Top(ft) 15,870' _ Bottom(ft): 15,905' ____ Max. Injection Pressure (psig): 2,500 psi Field Measurements and Observations Latitude (N): 30.870130 N _____________ Longitude (W): -87.128304 W __________ Elevation (ft): NA _________ EPA GPS ID: PG No. Well Status (see table): AC If not Active, Reported Date Last Active: _________________________ 3358766066 ________ Nature of Injected Fluid(s) if any: __________________________________________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): Internal pressure reading was 1,700 psi. DEP indicated this well was formerly equipped with a nitrogen release to release pressure back to the plant, instead of bursting the well. DEP indicated that the connection has been disconnected and sealed off. The operator confirmed this statement. The EPA Inspection Team's visual inspection confirmed that it appears to be disconnected and sealed off. The site was clean and well-maintained. There was no evidence of leaks or excessive corrosion. Perfs (see well schematics): 15,870-15905' perf 4 SPF GR 7/23/1976 R_e_p_e_r_f_1_5_,_8_8_6_'_-9_0_6__' _G_R__4_/_8_4_____________________________________________________________________________ _____________________________________________________________________________________________________ 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 6 Year-Month-Day: 2 0 2 2 - 0 9 - 1 3 EPA Permit # (or RA): 6 8 6 Page 2 Of 2 (Cont) ________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Photographer: Jason Rose ____________________________EPA Camera ID: PG camera ID no. 14 S/N:31029537 _______ Photo ID: 1 _______________Time: 7:55 AM ____ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking east, Curtis B. Lowery #10-E sign alongside access road.___________________________________ Photo ID: 2 _______________Time: 8:01 AM ____ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking south, closeup view of surface casing pressure gauge reading 0 psi._________________________ Photo ID: 3 _______________Time: 8:03 AM ____ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking south, closeup view of casing pressure relief gauge reading 0 psi.___________________________ Photo ID: 4 _______________Time: 8:06 AM ____ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking north, closeup view of internal pressure gauge reading 1,700 psi. __________________________ Photo ID: 5 _______________Time: 8:09 AM ____ Lat (N): NA __________________ Long (W): NA___________________ Description: View, looking south, of formerly-used casing pressure relief system. These lines are no longer connected to the well, and are sealed.______________________________________________________________________________ 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 Site Photographs Curtis B. Lowery #10-E: September 13, 2022 Photograph 1: Looking east, Curtis B. Lowery #10-E sign alongside access road. Page 1 of 5 Photograph 2: Looking south, closeup view of surface casing pressure gauge reading 0 psi. Page 2 of 5 Photograph 3: Looking south, closeup view of casing pressure relief gauge reading 0 psi. Page 3 of 5 Photograph 4: Looking north, closeup view of internal pressure gauge reading 1,700 psi. Page 4 of 5 Photograph 5: View, looking south, of formerly-used casing pressure relief system. These lines are no longer connected to the well, and are sealed. Page 5 of 5