Document dY0xK8zDb7Zx7pomwyn44jBXe
Inspection ID
Facility Contact Information
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): Carl E. Weller
_ (lead),
,
EPA Well ID#: F L S 1 1 3 0 0 5 7
Year-Month-Day: 2 0 2 3 - 0 3 - 2 9
EPA Permit # (or RA): F L I 0 0 1 0
Page 1 Of 2
Carol Chen
Start Time: 10:56 am
End Time: 11:05 am
Facility Name: Maverick Natural Resources, LLC (Breitburn Operating LP)
Street Address: 5415 Oil Plant Rd
City: Jay
County: Santa Rosa
State: FL Zip: 32565
Nature of Business: oil and gas production
Facility Owner/Operator: Maverick Natural Resources, LLC
Phone: 850-675-1702
Email:
Facility Contact (if different): Al Jones, Plant Superintendent
O/O Mailing Address: 5415 Oil Plant Rd
City:
Jay
County: Santa Rosa
Phone: 251-227-3319 State: FL Zip: 32565
Well Name & #: St. Regis SWDS #1-3
API No. 0911320206
PA No. 311643
Well Type (see table): Produced Water Disposal (PWD)
State Permit:
OG_1093
Latitude (N):
30.96795562
Longitude (W):
-87.18226683 Elevation (ft):
Lower Baker FAB-1 @6110'
Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing
PBTD: 6655' Total Depth (ft): 6783'
Other:
surface casing 10" @2314' Upper BHA Halliburton BWD 75400-A Packer
Inner Casing Size (in):
Tubing Size (in):
Packer Depth (ft): @6106'
Inj. Zone: Open Hole; X Perforated; Top(ft) 6274' Bottom(ft): 6662' Max. Injection Pressure (psig):1800 psi
Latitude (N):
30.96797
Longitude (W): -87.18224
Elevation (ft):
EPA GPS ID: SX8123 Well Status (see table): AC If not Active, Reported Date Last Active:
Nature of Injected Fluid(s) if any:
Produced fluids
General Condition of the Well Site:
Well Data from File
Field Measurements and Observations
Notes & Comments (include discrepancies from database values):
Inject well passed a mechanical integrity on 4/14/2021.
Perforations (Tuscaloosa Formation):
6274' to 6504'
Tubing gauge:
Production gauge
Surface gauge:
100 psi 0 psi 0 psi
Name: Signature:
See reverse for additional observations, comments and photo log
UIC Inspector
UIC Inspector
Carl E. Weller
Digitally signed by CARL WELLER
CARL WELLER (Affiliate) (Affiliate)
Date: 2023.05.17 10:16:04 -04'00'
Name:
Carol Chen
CAROL CHEN Date: 2023.05.15 17:12:51 -04'00' Digitally signed by CAROL CHEN
Signature:
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)
EPA Well ID#: F L S 1 1 3 0 0 5 7 Year-Month-Day: 2 0 2 3 - 0 3 - 2 9
EPA Permit # (or RA): F L I 0 0 1 0
Page 2 Of 2
Field Measurements and Observations (Cont.)
Photo Log
Photographer: Photo ID: Description: Photo ID: Description:
Carl E. Weller
EPA Camera ID:
SX8123
172
Time: 10:55 am Lat (N): 30.96797
Long (W) -87.18224
up-close photo of sign posted on the injection well, closest GPS location
173
Time: 10:55 am Lat (N): 30.96798
Long (W) -87.182234
photo, a few steps back from the injection well
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:
UIC Inspector
Name: Signature:
Carl E. Weller
Digitally signed by CARL WELLER
CARL WELLER (Affiliate) (Affiliate)
Date: 2023.05.17 10:16:32 -04'00'
UIC Inspector
Name: Carol Chen
CAROL CHEN Digitally signed by CAROL CHEN Date: 2023.05.15 17:13:22 -04'00'
Signature:
Version 2018-04-18