Document jmme438mELKoY9MyG2ojG44GR
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):
Carol Chen
_ (lead), ,
EPA Well ID#: F L S 1 1 3 0 0 1 0 Year-Month-Day: 2 0 2 4 - 0 5 - 0 1
EPA Permit # (or RA):
Carla Foy
Page 1 Of 2
Start Time: 1:40 pm End Time: 1:45 pm
Facility Contact Information
Facility Name: Street Address: City:
Black Creek Energy, LLC
4940 Blackjack Plant Rd.
Jay
County:
Santa Rosa
Nature of Business:
Oil and gas production
Facility Owner/Operator:
Harris D. Butler, III
Email:
harris.butler@butlerroyals.com
Facility Contact (if different):
O/O Mailing Address: 140 Virginia Street, Suite 302
City:
Richmond
County:
N/A
State: FL
Zip:32565-9260
Phone: (804)-334-0527
Phone:
State: VA Zip: 23219
Well Data from File
Well Name & #:
W. W. Foskett #25-N (BJC #25-N)
Well Type (see table):
Enhanced Oil Recovery (EOR)
Latitude (N): 30.83372192
Longitude (W):
API No. 0911320136 PA No. 303039
State Permit:
-87.09530478
OG_728
Elevation (ft):
Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing
PBTD: 16018'
Total Depth (ft):
16120'
Other: srfc csg 9" @3925'
Inner Casing Size (in):
Tubing Size (in):
(1974-06) Otis WB pkr set at 15700' Perma Pak-D
Packer Depth (ft): 15607'
Inj. Zone: Open Hole; X Perforated; Top(ft) 15958' Bottom(ft): 15992' Max. Injection Pressure (psig): 2500 psi
Latitude (N): No GPS 000
Longitude (W):
No GPS 000
Elevation (ft):
EPA GPS ID: SX8123 Well Status (see table): SI
If not Active, Reported Date Last Active: 11/13/23
Nature of Injected Fluid(s) if any:
General Condition of the Well Site:
Field Measurements and Observations
Notes & Comments (include discrepancies from database values):
This well is inactive, shut-in.
Tubing gauge: Production gauge: Surface gauge:
unable to read this gauge 0 psi 0 psi
Name:
See reverse for additional observations, comments and photo log
U IC Inspector
UIC Inspector
Carol Chen
Name:
Signature: CAROL CHEN
Digitally signed by CAROL CHEN Date: 2024.06.24 10:56:25 -04'00'
Signature:
UIC Inspector:
UIC Inspector:
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)
W. W. Foskett #25-N (BJC #25-N)
EPA Well ID#: F L S 1 1 3 0 0 1 0 Year-Month-Day: 2 0 2 4 - 0 5 - 0 1
EPA Permit # (or RA):
Page 2 Of 2
Field Measurements and Observations (Cont.)
Photo Log
Photographer:
Carol Chen
Photo ID: DSCN1441 Time:
1:44 pm
EPA Camera ID:
Lat (N): No GPS 000
Description: well identification sign at property entrance
Photo ID: DSCN1442 Time: 1:45 pm Lat (N): No GPS 000
Description: injection well
Photo ID: DSCN1443 Time: 1:46 pm Lat (N): No GPS 000
Description: surface gauge reads 0 psi
Photo ID: DSCN1444 Time: 1:46 pm Lat (N): No GPS 000
Description: production gauge reads 0 psi Photo ID: DSCN1445 Time: 1:46 pm Lat (N): No GPS 000 Description: tubing gauge, unable to read this gauge
Photo ID:
Time:
Lat (N):
Description:
Name:
U IC Inspector)
Carol Chen
Name:
Signature: CAROL CHEN
Digitally signed by CAROL CHEN Date: 2024.06.24 10:56:50 -04'00'
Signature:
SC8284
Long (W)
No GPS 000
Long (W) No GPS 000
Long (W) No GPS 000
Long (W) No GPS 000
Long (W) No GPS 000
Long (W)
UIC Inspector
Version 2018-04-18
UIC Inspector:
UIC Inspector: