Document np3x227O3zv7r3wyQ5jyw5oJw
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 Year-Month-Day: 2 0 2
EPA Permit # (or RA):
Carol Chen
1 1 30 0 7 2 3 -03 - 28 F L I 0038
Page 1 Of 2
Start Time:11:32 am End Time:11:39 am
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:
Black Creek Energy, LLC
Email:
Mike Wetzel <mikew2859@gmail.com>
Facility Contact (if different):
Michael Wetzel
O/O Mailing Address: 140 Virginia Street, Suite 302
City:
Richmond
County:
N/A
State: FL
Zip:32565-9260
Phone: 601-431-5386 Phone: 850-324-6271
State: VA Zip: 23219
Well Data from File
Well Name & #: H. A. Singletary #13-N
Well Type (see table):
Producer
Latitude (N): 30.8607852
Longitude (W):
API No. 0911320112 PA No. 303042
State Permit:
-87.09871823
OG_ 659
Elevation (ft):
Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing
PBTD: 15955' Total Depth (ft): 16103'
Other: srfc csg 10" @4185'
Inner Casing Size (in):
Tubing Size (in):
Baker Packer Depth (ft): 15620'
Inj. Zone: Open Hole; X Perforated; Top(ft) 15876' Bottom(ft): 15935' Max. Injection Pressure (psig):
Latitude (N):
30.86068
Longitude (W):
-87.09872
Elevation (ft):
EPA GPS ID: SX8123 Well Status (see table): NI
If not Active, Reported Date Last Active:
Nature of Injected Fluid(s) if any:
General Condition of the Well Site:
Field Measurements and Observations
Notes & Comments (include discrepancies from database values): NI: Not an injection well
This producer is on the operator's list, planned to be plugged and abandoned for final closure.
Tubing gauge:
1200 psi
Production gauge:
unknown
Surface gauge:
0 psi
Mechanical Integrity test passed on 9/20/2021
See reverse for additional observations, comments and photo log
UIC Inspector
UIC Inspector
Name: Signature:
Carl E. Weller
CARL WELLER (Affiliate)
Digitally signed by CARL WELLER (Affiliate) Date: 2023.05.11 13:43:34 -04'00'
Name: Carol Chen
CAROL CHEN Digitally signed by CAROL CHEN Date: 2023.05.10 20:07:01 -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 2 Year-Month-Day: 2 0 2 3 - 0 3 - 2 8
EPA Permit # (or RA): F L I 0 0 3 8 Page 2 Of 2
Field Measurements and Observations (Cont.)
Photo Log
Photographer: Photo ID: Description: Photo ID: Description:
Carl E. Weller
EPA Camera ID:
148
Time: 11:31 am Lat (N):
30.86044
sign posted
149
Time: 11:32 am Lat (N):
30.86068
photo of producer
SX8123
Long (W)
-87.09892
Long (W)
-87.09872
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:
Name: Signature:
UIC Inspector
Carl E. Weller
Digitally signed by CARL WELLER
CARL WELLER (Affiliate) (Affiliate)
Date: 2023.05.11 13:44:03 -04'00'
UIC Inspector
Name: Carol Chen
CAROL CHEN Digitally signed by CAROL CHEN Date: 2023.05.10 20:07:30 -04'00'
Signature:
Version 2018-04-18