Document ek0d470rRaJJ6r08MDkKaKzG
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 1 1 Year-Month-Day: 2 0 2 3 - 0 3 - 3 0
EPA Permit # (or RA): N O N E
Page 1 Of 2
Carol Chen
Start Time: 9:40 am
End Time: 9:46 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 & #: B. G. Addison Etal #5-3
API No. 0911320011 PA No. 302984
Well Type (see table):
Enhanced Oil Recovery (EOR)
State Permit:
OG_470
Latitude (N): 30.9708225
Longitude (W):
-87.15294411
Elevation (ft):
Lower
Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing Baker FB-1@15222.5'
PBTD: 15673' Other: surface casing 10" @ 3709'
Upper BHA Baker FB-1 Packer
Total Depth (ft): 15845' Inner Casing Size (in):
Tubing Size (in):
Packer Depth (ft)@: 15055'
Inj. Zone: Open Hole; X Perforated; Top(ft) 15436' Bottom(ft): 15646' Max. Injection Pressure (psig):4,400 PW
Latitude (N):
30.97086
Longitude (W):
-87.15306
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): Maximum injection pressures: Nitrogen (N), 7500 psi
Perforations (Smackover Formation):
Produced Water (PW), 4400 psi
15436' to 15490' (GR-4SPF) 5/26/1974
Well passed a mechanical integrity test on 6/28/2022.
15530' to 15550' (GR-4SPF) 5/09/1974 Tubing gauge:
2400 psi
15570' to 15599' (GR-4SPF) 9/30/1972 Production gauge
0 psi
15599' to 15615' (GR-4SPF) 8/12/1972 Surface gauge:
0 psi
15615' to 15646' (GR-4SPF) 9/30/1972
Flowline gauge:
2800 psi
See reverse for additional observations, comments and photo log
UIC Inspector
UIC Inspector
Name: Signature:
Carl E. Weller
Digitally signed by CARL WELLER
CARL WELLER (Affiliate) (Affiliate)
Date: 2023.05.23 15:03:26 -04'00'
Name:
Carol Chen
CAROL CHEN Date: 2023.05.16 15:34:14 -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 1 1 Year-Month-Day: 2 0 2 3 - 0 3 - 3 0
EPA Permit # (or RA): N O N E
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
186
Time: 9:38 am Lat (N): 30.97086
Long (W)
sign posted directly on the injection well, close-up photo
187
Time: 9:39 am Lat (N):
30.97085
injection well seen, a few feet away
Long (W)
-87.15306 -87.15301
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 15:03:59 -04'00'
UIC Inspector
Name: Carol Chen
CAROL CHEN Date: 2023.05.16 15:34:42 -04'00' Digitally signed by CAROL CHEN
Signature:
Version 2018-04-18