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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 1 5 3 0 1 4 5 Year-Month-Day: 2 0 2 4 - 1 0 - 2 2 EPA Permit # (or RA): R A Phone: (404)562-9424 Page 1 Of 2 Inspector(s): _C_a__ro__l _C_h_e__n______________________ (lead),___L_o__n_n_i_e__D__o_r_n___________________ Start Time1: _1_:_0__9__a_m__ ____________________________________, ____________________________________ End Time:1_1__:1__2__a_m__ Facility Contact Information Facility Name:___S__l_o_n_e__E__n_e_r_g__y_,_L_L__C____________________________________________________________________ Street Address:__8__9_6_6__K__Y__R__T__4_0__W__e__s_t_, _P_._O__._B__o_x__2_2__0__________________________________________________ City: _____Oil Springs _______________ County:______M__a_g_o_f_f_in__________________ State:__K_Y_____ Zip: 41238 Nature of Business: ___o__il_p__r_o_d_u__c_ti_o_n_____________________________________________________________________ Facility Owner/Operator: _____M__r.__S_.__C_h__ri_s__S_l_o_n__e_,_P__E______________________ Phone: _6_0__6_._2_9__7_._5_3__3_0__w__o__rk___ Email: ________c_h__r_is_s_l_o_n__e_@__s__lo_n__e_e_n__e_r_g_y_._c_o_m___________________________________________________________ Facility Contact (if different): ________________________________________________ Phone: _6_0__6_.2__2_5_._2_2__0_6__c_e__ll_____ O/O Mailing Address: ____________________________________________________________________________________ City: _______________________________ County: _______________________________ State:________ Zip: _________ Well Data from File Well Name & #: _________J_.__P_.__C__O__N_L__E__Y__#_W___-_4_________________________________________________________ Well Type (see table): _C__la_s__s_I_I_-_R_,__E_n__h_a_n__c_e_d__O__il__R_e__c_o_v_e__ry__(_E__O__R_)__ State Permit: __________________________ Latitude (N): _______3_7_._7_7__9_8_1___________ Longitude (W): ____-_8_3__.0__0_8_7__8__________ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; XTubing & Packer; Cemented Injection Tubing Other: _4____"__p_r_o__d_u_c__ti_o_n___c_a_s__in__g________________________________________ Total Depth (ft): __________ Inner Casing Size (in): _2______"_ Tubing Size (in):___1_"______ Packer Depth (ft): ________ Inj. Zone: Open Hole; Perforated; Top(ft) ________ Bottom(ft): ___________ Max. Injection Pressure (psig): ________ Field Measurements and Observations Latitude (N): ________0_0__0_______________ Longitude (W): _______0__0_0______________ Elevation (ft): ____________ EPA GPS ID: S__7__5_3__3_2_ Well Status (see table): ___A__C____ If not Active, Reported Date Last Active: __________________ Nature of Injected Fluid(s) if any: ____P_r_o_d__u_c_e_d__W___a_t_e_r_s__(P__W__)_______________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): ______________________________________________________ _____________________________________________________________________________________________________ _T__h_e__in__je__c_ti_o_n__l_in__e__is__c_o__n_n_e__c_te__d_,_f_e_e__ls__i_c_y__c_o_l_d_._T__h_e__w__e_l_l _in__je__c_ts__p__ro__d_u_c__e_d__w__a_t_e_r_s_f_o_r_______________ _e_n_h__a_n_c__e_d__o_i_l _r_e_c_o_v__e_r_y_._N__o__g_a__u_g_e__s_a__r_e__a_t_ta__c_h_e_d__t_o__m__o_n__it_o_r__in_j_e_c__ti_o_n__a_n__d__a_n_n__u_lu__s__p_r_e_s_s_u__r_e_s_._____ _W__e__ll_c_a__p__s_h__o_w__s__c_o__rr_o__s_i_o_n_.________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ See reverse for additional observations, comments and photo log 8,&,QVSHFWRU UIC Inspector Carol Chen Name:______________________________________________ Name: ______________________________________________ Signature: _C_A__R__O__L__C_H__E__N_______D_a_te_: _20_2_4._12_.1_0_1_8:0_8_:2_9_-0_5_'00_' ___ 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#: K Y S 1 5 3 0 1 4 5 Year-Month-Day: 2 0 2 4 - 1 0 - 2 2 EPA Permit # (or RA): R A Page 2 Of 2 (Cont) ________________________________________________________________________________________________ _________J__._P__.__C__O__N__L__E_Y___#__W__-_4________C__la__s_s__I_I-_R__,__E_n__h_a__n_c_e__d__O__i_l _R__e_c_o__v_e__ry__(_E__O__R__)_____________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Photo Log Photographer:_C__a_r_o_l__C__h_e_n__________________________EPA Camera ID: _S__7_5_3__3_2______________________________ Photo ID: _R__IM___G__0_1_8__9_____Time: _1_1__:0__9__a__m__ Lat (N): _____0_0_0______________ Long (W) ____0_0__0_______________ Description: __i_n_j_e__c_t_i_o_n___w__e__ll_________________________________________________________________________ Photo ID: _________________Time: ____________ Lat (N): _____________________ Long (W) ______________________ Description: ___________________________________________________________________________________________ Photo ID: _________________Time: ____________ Lat (N): _____________________ Long (W) ______________________ Description: ___________________________________________________________________________________________ Photo ID: _________________Time: ____________ Lat (N): _____________________ Long (W) ______________________ Description: ___________________________________________________________________________________________ Photo ID: _________________Time: ____________ Lat (N): _____________________ Long (W) ______________________ Description: ___________________________________________________________________________________________ Photo ID: _________________Time: ____________ Lat (N): _____________________ Long (W) ______________________ Description: ___________________________________________________________________________________________ 8,&,QVSHFWRU UIC Inspector Carol Chen Name:______________________________________________ Name: ______________________________________________ Signature: _C_A__R__O_L__C__H__E_N________D_a_te_: 2_0_24_.1_2_.1_0 _18_:0_8:_53_-_05_'0_0_' ___ Signature: ___________________________________________ Digitally signed by CAROL CHEN Version 2018-04-18