Document npRrEy5N8aNx1G5ZXpQG6Y2x8

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#: F L S 1 1 3 0 0 2 9 Year-Month-Day: 2 0 2 4 - 0 5 - 0 1 EPA Permit # (or RA): Page 1 Of 2 Inspector(s): ______C_a_r_o_l_C__h_e_n___________________ (lead), ______C_a__rl_a__F_o_y_____________________ Start Time: _1_1_:_0_7__a__m_ ____________________________________ , _______________________________________ End Time: 1__1_:_1_2__a__m_ Facility Contact Information Facility Name:__M__a_v_e_r_i_c_k__N_a_t_u_r_a__l _R_e_s__o_u_r_c_e_s_,__L_L_C________________________________________________________ Street Address:_5__4_1__5__O_i_l _P_l_a_n_t__R_d_______________________________________________________________________ City: _____J_a_y________________________ County: ___S__a_n_t_a__R_o__s_a_________________ State:___F_L____ Zip: _3__2_5__6_5__ Nature of Business: _____o_i_l _a_n_d__g_a__s_p__ro__d_u_c_t_i_o_n___________________________________________________________ Facility Owner/Operator: _M__a_v_e__r_ic_k__N__a_t_u_r_a_l_R__e_s_o_u__rc_e__s_,_L_L_C________________ Phone: _8__5_0__-6__7_5_-_1_7__0_2_________ Email: ________________________________________________________________________________________________ Facility Contact (if different): __A_l__J_o_n_e_s_,__P_l_a_n_t__S_u_p_e__r_in_t_e_n__d_e_n__t _______________ Phone: __2_5_1__-2__2_7__-3__3_1_9_________ O/O Mailing Address: ___5_4__1_5__O__il_P__la__n_t_R__d________________________________________________________________ City: ______J_a_y_______________________ County: ____S__a_n_t_a__R_o__s_a________________ State:__F_L_____ Zip: __3_2__5_6_5__ Well Data from File Field Measurements and Observations Well Name & #: ________S_T_._R__E_G__IS__P__A_P_E__R__C_O__M_P__A_N__Y__#_2_9__-2_________A_P_I_N_o_._0__9_-1_1__3_-2_0__1_2_7_____P_A__N_o_._3_1__1_5_9_6___ Well Type (see table): ____E_n_h__a_n_c_e__d_O__i_l _R_e_c__o_v_e_r_y__(E__O_R__) _____________ State Permit: ____O_G____6__0_3_______________ Latitude (N): ________3__0_.9__2_2__1_1_5________ Longitude (W): _____-_8_7__._1_3_6__6_8__7_______ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing PBTD: 15913' Other: __________________________________________________________________ 15995' 7" at 15995 4 1/2" at 15275' 15280' Total Depth (ft): __________ Inner Casing Size (in): ________ Tubing Size (in):__________ Packer Depth (ft): ________ Inj. Zone: Open Hole; X Perforated; Top(ft) _1_5__5_8__9_' Bottom(ft): __1__5_7_2__0_'__ 7500 N2 gas Max. Injection Pressure (psig):4_4_0_0_p_s_i_P_W Latitude (N): _____N_o__G__P_S__0__0_0__________ Longitude (W): ____N__o__G_P__S__0_0_0_________ Elevation (ft): ____________ SC8284 EPA GPS ID: _________ 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__te_r_s__(P__W_)__________________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): ______________________________________________________ D__A_N__G_E_R__s_i_g_n_: _H__S__M_a__y_b_e__P_r_e_s_e_n_t_.._._H_a_z_a_r_d_o_u_s__O_p_e__ra__ti_o_n_s_._.._K_e_e_p__O_u__t._..____________________________________ ___"_T_-_s_k_il_le__t _w_a_s__in__s_e_r_te_d__o_n__t_h_e_N__it_r_o_g_e_n__(N___)_g_a_s__li_n_e__to__s_t_o_p__g_a_s_i_n_j_e_c_ti_o_n_.________________________________ ________________________________________________________T_u_b_i_n_g__G_a_u_g__e_: _________1_5__0_0__p_s_i_______________ ________________________________________________________P_r_o_d_u_c_t_i_o_n_G__a_u_g_e_:______0__p_s_i___________________ ________________________________________________________S_u_r_f_a_c_e__G_a_u__g_e_: _________0__p_s_i __________________ ________________________________________________________F_l_o_w__L_in_e__G__a_u_g_e_:______________________________ See reverse for additional observations, comments and photo log UIC Inspector UIC Inspector Name:_______C_a_r_o_l _C_h_e__n_______________________________ Name: ______________________________________________ Signature: _C_A__R__O__L__C__H_E__N_______D_a_te_: _20_2_4._06_.2_0_2_1:_49_:2_1_-0_4_'0_0'___ 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#: F L S 1 1 3 0 0 2 9 Year-Month-Day: 2 0 2 4 - 0 5 - 0 1 EPA Permit # (or RA): Page 2 Of 2 (Cont) ________________________________________________________________________________________________ ______S_T_.__R_E_G__I_S__P_A_P_E__R__C_O__M__P_A_N__Y__#_2__9_-_2___________O_G____6_0__3_________________A__P_I_N__o_._0_9__-1__1_3__-2__0_1_2__7____ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Photo Log Photographer: _____C__a_r_l_a_F__o_y_________________ EPA Camera ID:_________S__C_8__2_8_4_____________________________ Photo ID: ___D__S_C_N__1_4__0_5____Time: _1__1_:_0_8__a_m___ Lat (N): ___N_o__G__P_S__0__0_0_______ Long (W) ___N__o__G_P__S__0_0_0________ Description: _i_n_j_e_c_t_io__n_w__e_l_l,__id_e__n_t_if_i_c_a_t_io__n_s__ig_n__, _D_A__N_G__E_R__s_i_g_n_:__H__S__M__a_y__b_e__P_r_e_s_e_n__t._._.K__e_e_p__O__u_t_.._._________ Photo ID: ___D__S_C_N__1_4__0_6____Time: _1__1_:_1_0__a_m___ Lat (N): ___N_o__G__P_S__0_0__0_______ Long (W) ___N__o_G__P_S__0__0_0________ Description: _i_n_j_e_c_t_io__n__tu__b_in__g__g_a_u_g__e_r_e_a__d_s__1_5__0_0__p_s_i____________________________________________________ Photo ID: ___D__S_C_N__1_4__0_7____Time: _1_1_:_1_1__a_m____ Lat (N): __N__o__G_P__S__0_0_0________ Long (W) ___N_o__G__P_S__0__0_0________ Description: __s_u_r_fa__c_e__g_a_u_g__e_r_e__a_d_s__0__p_s_i________________________________________________________________ Photo ID: ___D__S_C__N_1__4_0_8____Time: _1_1_:_1_2__a_m____ Lat (N): __N__o_G__P_S__0__0_0________ Long (W) ___N_o__G__P_S__0__0_0________ Description: _p__r_o_d_u_c_t_i_o_n__g_a_u__g_e__r_e_a_d_s__0__p_s_i_____________________________________________________________ Photo ID: _________________Time: ____________ Lat (N): _____________________ Long (W) ______________________ Description: ___________________________________________________________________________________________ Photo ID: _________________Time: ____________ Lat (N): _____________________ Long (W) ______________________ Description: ___________________________________________________________________________________________ UIC Inspector UIC Inspector Name:_______C_a_r_o_l_C__h_e_n_______________________________ Name: ______________________________________________ Signature: _C_A__R__O_L__C__H__E_N________D_a_te_: 2_0_24_.0_6_.20_2_1_:4_9:_48_-0_4_'0_0'____ Signature: ___________________________________________ Digitally signed by CAROL CHEN Version 2018-04-18