Document jMe21LK730KdGg1ObZOwMxv9

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 0 9 9 0 0 0 3 Year-Month-Day: 2 0 2 4 - 0 2 - 2 1 EPA Permit # (or RA): K Y I 0 3 9 9 Phone: (404)562-9424 Page 1 Of 2 Inspector(s): _____C__a_r_o_l_C__h_e_n__________________ (lead),______B_r_i_a_n_n__a__L_a_P_a__p_a_____________ Start Time: _9__:5__1_a__m__ ____________________________________, ____________________________________ End Time: _1_0_:_0_4__a_m__ Facility Contact Information Logsdon Valley Oil Co., Inc. Facility Name: __________________________________________________________________________________________ Street Address:______1__0_5__B__e_d_f_o_r_d__C_o__u_r_t________________________________________________________________ City: ____H_o_r_s_e__C__a_v_e_________________ County: _________H_a_r_t___________________ State:___K__Y___ Zip: _4__2_7__4_9__ Nature of Business: _______O_i_l_a_n__d__g_a_s__e_x_t_r_a_c_t_io__n_________________________________________________________ Facility Owner/Operator: ________L__o_g_s_d__o_n__V_a_l_le__y_O__il_C__o_._,_I_n_c_.______________ Phone: ____2__7_0_-_5_3__7_-_4_2__8_8______ Email: _______e_s__ti_n_s_o__n_@__s_c_r_tc__.c_o__m______________________________________________________________________ Facility Contact (if different): _____E_l_le_n__S__ti_n_s_o__n_,_P_r_e__s_id_e__n_t____________________ Phone: ____2_7__0_-_5_3__7_-_4_2__8_8______ O/O Mailing Address: ________1_0__5__B_e_d__fo__rd__C__o_u_r_t__________________________________________________________ City: ______H__o_r_s_e__C_a_v_e_______________ County: ________H__a_r_t___________________ State:____K_Y___ Zip: __4_2__7_4__9_ Well Data from File Well Name & #: _________L_o__r_a__T_u__r_n_e_r__#__5_______________________________________________________________ Well Type (see table): ___E_n_h_a__n_c_e_d__O__il__R_e_c_o__v_e_r_y_(_E_O__R_)_______________ State Permit: _______4_6__6__0_5_____________ Latitude (N): _______3_7__.1__8_3__9_6__________ Longitude (W): _______-8__5_._7_8_3__1_6________ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; XTubing & Packer; Cemented Injection Tubing PBTD: Other: ___s_u_r_f_a_c_e__c_a_s_i_n_g_:__6___"____________________________________________ Total Depth (ft): ___6__3_8_'___ Inner Casing Size (in):4___"_t_o_2_8_4'Tubing Size (in):___2____"___ Packer Depth (ft): _5__9_7__' __ Inj. Zone: Open Hole; Perforated; Top(ft) ________ Bottom(ft): ___________ Max. Injection Pressure (psig): ________ Field Measurements and Observations Latitude (N): _____3__7_._1_8__3_8__8_8_9_________ Longitude (W): _ -85.783056 Elevation (ft): ____________ EPA GPS ID: _S_7_5__3_3__2_ Well Status (see table): ____IN_____ If not Active, Reported Date Last Active: ____9_/_1__3_/_2__0_1__9___ Nature of Injected Fluid(s) if any: __________________________________________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): ______________________________________________________ _L_a_s_t__m_e__c_h_a_n__ic_a__l _in__te__g_ri_t_y_d__e_m__o_n_s_t_r_a_t_i_o_n__p_e_r_f_o_r_m__e_d__o_n__3_/_1__6_/_2__0_2_3__._________________________________ _W__e_l_l _is__n_o__t _a_c_t_iv__e_._N__o_g__a_u_g_e__s_a_r_e__p_r_e_s__e_n_t_.__W_e__h__e_a_r_d__p_u_m__p__e_r_i_s__w_o_r_k_i_n_g__o_n__t_h_e__i_n_j_e_c_t_io_n__w__e_l_l.________ _U_n__li_n_e_d__p__it_h__o_l_d_s__p_r_o_d_u__c_e_d__f_lu_i_d_s_.__T_a_n_k__b_a__tt_e_r_y__is__h_e__a_v_i_ly__c_o_r_r_o_d_e_d__._________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ See reverse for additional observations, comments and photo log UIC Inspector UIC Inspector Name:_______C_a__r_o_l__C_h__e_n_____________________________ CAROL CHEN Digitally signed by CAROL CHEN Date: 2024.03.27 18:50:27 -04'00' Signature: ___________________________________________ Name: ______________________________________________ Signature: ___________________________________________ 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 0 9 9 0 0 0 3 Year-Month-Day: 2 0 2 4 - 0 2 - 2 1 EPA Permit # (or RA): K Y I 0 3 9 9 Page 2 Of 2 (Cont) __U_I_C__C_l_a_s_s__I_I____L__o_r_a__T_u_r_n_e_r__#_5_________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Photo Log Brianna LaPapa S75332 Photographer:______________________________________EPA Camera ID: ______________________________________ Photo ID: __R_IM__G__0_0_2__5______Time: _1__0_:0__0__a_m___ Lat (N): ____3__7_._1_8_4_0__0_6_______ Long (W) _____-8_5__.7__8_3_2_0__3_______ Description: _t_a_n__k_b__a_t_te__r_y______________________________________________________________________________ Photo ID: __R_I_M_G__0_0_2__6______Time: _1__0_:0__0__a_m___ Lat (N): _____3_7_._1_8_3__9_6_9_______ Long (W) ____-_8_5__.7_8__3_1_7__5_______ Description: _b__e_s_i_d_e__t_a_n_k__b_a_t_t_e_r_y_,_u__n_li_n_e_d__p__it__o_f_p_r_o_d__u_c_e_d__f_l_u_i_d_s________________________________________ Photo ID: __R_IM__G__0_0_2__7______Time: _1_0_:_0_0__a_m____ Lat (N): ___3__7_._1_8_3_9__9_________ Long (W) ___-8_5__.7__8_3_1__4_3_________ Description: _i_n_j_e_c_t_io__n__w_e_l_l_w__it_h__g_r_e_e_n__f_l_o_w__l_in_e__________________________________________________________ Photo ID: __R_IM__G__0_0_2__8______Time: _1_0__:0_0__a_m____ Lat (N): ___3_7__.1__8_3_9_8__5________ Long (W) __-_8_5_._7_8__3_1_5___________ Description: __c_lo__s_e_-u__p__o_f_i_n_j_e_c_t_io__n__w_e_l_l_s_h_o__w_s__r_e_d_d__is_h__c_o__rr_o_s__io_n__o__n_t_u__b_in__g_a__n_d__c_a_s_i_n_g___________________ Photo ID: __R_I_M_G__0_0_2__9______Time: _1_0_:0__1_a_m_____ Lat (N): ___3__7_._1_8_3_9__8_5________ Long (W) __-_8_5__.7_8__3_1_3__8_________ Description: _ta__n_k__b_a_t_t_e_r_y__h_e_a_v_i_l_y_c_o__rr_o_d__e_d__d_o_w__n__t_h_e__s_id__e_,_s_h__o_w_i_n_g__w__h_i_te__a_n__d__re__d_d_i_s_h_-_o_r_a_n_g__e_c__o_r_ro__s_io__n_ Photo ID: __R_I_M__G_0_0__3_0______Time: _1_0_:_0_4_a_m_____ Lat (N): ___3__7_.1__8_3_9__8_________ Long (W) __-_8_5_._7_8__3_1_5_3__________ Description: __in__je_c__ti_o_n__w__e_ll__a_n_d__g_r_e_e__n_f_l_o_w__l_in__e_________________________________________________________ U IC Inspector UIC Inspector Carol Chen Name:_______________________________________________ CAROL CHEN Date: 2024.03.27 18:50:55 -04'00' Digitally signed by CAROL CHEN Signature: ___________________________________________ Name: ______________________________________________ Signature: ___________________________________________ Version 2018-04-18