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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 Phone: (404)562-9424 EPA Well ID#: K Y S 1 5 3 0 1 4 7 Year-Month-Day: 2 0 2 4 - 1 0 - 2 2 EPA Permit # (or RA): R A Page 1 Of 2 Inspector(s): _C_a__ro__l _C_h_e__n______________________ (lead),____L_o_n__n_ie__D__o_r_n___________________ Start Time:1_1__:2__9__a_m__ ____________________________________, ____________________________________ End Time: 1__1_:_3_0__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_fi_n___________________ State:__K_Y_____ Zip: 4_1__2_3_8_ __ 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_r_k___ Email: ________c_h__ri_s_s_lo__n_e_@__s_l_o_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___-_6______________________________________________________ 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__7_8_5___________ Longitude (W): _____-8__3_._0_0_9__2_5__________ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; XTubing & Packer; Cemented Injection Tubing Other: __4_____"__p__r_o__d__u__c_t_i_o_n___c__a_s__i_n__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): ______3_7__.7__7_8__5_7_2__________ Longitude (W): _____-_8__3_._0_0__7_8_2__5_______ 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__j_e_c__t_io__n__l_i_n_e___i_s__c_o__n__n_e__c_t_e__d__a__n__d__f_e__e_l_s__i_c_y___c_o__l_d_.__P__r_o__d_u__c_e__d__w___a_t_e__r_s__a__r_e_________ _b__e_i_n__g__i_n_j_e_c__te__d__f_o__r_e__n_h__a_n__c_e__d__o__il__r_e_c__o_v__e_r_y_.__N__o__g__a_u__g_e__s__w__e__r_e__a__tt_a__c_h__e_d__t_o__m___o_n__i_to__r_____ _in__je__c_t_i_o_n___a_n__d__a__n_n__u_l_u_s__p__r_e_s__s_u__r_e_s__._____________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 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:_10_:3_1_-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 7 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___-_6___________C__l_a_s__s__I_I-_R__,__E__n_h__a_n__c_e__d__O__i_l_R__e__c_o__v_e__r_y__(_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__I_M__G__0_1__9_2___Time: _1_1__:2__9__a__m__ Lat (N): _3_7__._7_7__8_5_7__2_________ Long (W) ___-_8_3__.0__0_7__8_2__5_______ Description: _i_n__je__c_t_i_o_n___w__e__ll__________________________________________________________________________ Photo ID: ___R__IM__G__0_1__9_3____Time: _1_1__:2__9__a_m___ Lat (N): _3_7__.7__7_8_5__7_2__________ Long (W) ___-_8_3_._0_0__7_8_2__5________ Description: __in__j_e_c__t_io__n__w___e_l_l_,_a__n__o_t_h__e_r__a__n_g__l_e______________________________________________________ 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 1_8_:1_0:_54_-_05_'0_0'____ Signature: ___________________________________________ Digitally signed by CAROL CHEN Version 2018-04-18