Document dn8bGO2KyjxxzZgXnveDeYYNB
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
Inspector(s): Carl E. Weller
_ (lead),
,
EPA Well ID#: F L S 1 1 3 0 0 7 5
Year-Month-Day: 2 0 2 3 - 0 3 - 3 0
EPA Permit # (or RA): F L I 0 0 4 5
Page 1 Of 2
Carol Chen
Start Time: 9:25 am
End Time: 9:35 am
Facility Contact Information
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 Data from File
Well Name & #: C. D. Helms Etal #5-4
API No. 0911320063 PA No. 309890
Well Type (see table): Enhanced Oil Recovery (EOR)
State Permit:
OG_558
Latitude (N):
30.96911701
Longitude (W): -87.14391738
Elevation (ft): BHA #1 Pryor
Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing packer @15497'
PBTD: 16019'
Other:
surface casing 9" @3861'
BHA #2 Pryor packer @15317'
Total Depth (ft): 16110' Inner Casing Size (in):
9/24/2015 BHA #3 Baker packer
Tubing Size (in):
Packer Depth (ft): @15137'
Inj. Zone: Open Hole; X Perforated; Top(ft) 15708' Bottom(ft): 15821' Max. Injection Pressure (psig):
Field Measurements and Observations
Latitude (N):
30.96909
Longitude (W):
-87.14394
Elevation (ft):
EPA GPS ID: SX8123 Well Status (see table):
If not Active, Reported Date Last Active: 3/20/2022
Nature of Injected Fluid(s) if any:
General Condition of the Well Site:
Notes & Comments: Maximum injection pressures are 7500 psi Nitrogen (N), 4400 psi Produced Water (PW)
Notes & Comments (include discrepancies from database values): Well passed a mechanical integrity test on 3/09/2021
Perforations, Smackover Formation:
Injection well is not connected to any of the flowlines.
15708' to 15773' (4SPF - 61') 10/03/1972
15708' to 15761' (6SPF - 53') 12/19/2003 15714' to 15782' (4SPF - 68') 01/25/2014 15761' to 15791' (6SPF - 30') 12/18/2003 15791' to 15821' (6SPF - 30') 10/28/2003
Tubing gauge: Production gauge Surface gauge:
0 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: 2023.05.23 15:18:43 -04'00'
Name:
Carol Chen
CAROL CHEN Digitally signed by CAROL CHEN Date: 2023.05.22 16:41:27 -04'00'
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 7 5 Year-Month-Day: 2 0 2 3 - 0 3 - 3 0
EPA Permit # (or RA): F L I 0 0 4 5
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
184
Time: 9:24 am Lat (N):
30.96894
Long (W)
sign posted a distance away from the injection well
-87.14432
185
Time: 9:27 am Lat (N):
30.96909
Long (W) -87.14394
photo of injection well, several feet away, but provides the closest GPS location
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: 2023.05.23 15:19:08 -04'00'
UIC Inspector
Name: Carol Chen
CAROL CHEN Date: 2023.05.22 16:41:52 -04'00' Digitally signed by CAROL CHEN
Signature:
Version 2018-04-18