Document oDE9k1VemGjaZjR3KQxB9MGpE
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 1 1 3 0 0 3 3
Year-Month-Day: 2 0 2 3 - 0 3 - 3 0
EPA Permit # (or RA): N O N E
Page 1 Of 2
Carol Chen
Start Time: 10:30 am
End Time: 10:34 am
Facility Contact Information
Facility Name: Maverick Natural Resources, LLC (Breitburn Operating LP)
Street Address: 5415 Oil Plant Rd
City: Jay
County: Santa Rosa
State: FL Zip: 32565
Nature of Business: oil and gas production
Facility Owner/Operator: Maverick Natural Resources, LLC
Phone: 850-675-1702
Email:
Facility Contact (if different): Al Jones, Plant Superintendent
O/O Mailing Address: 5415 Oil Plant Rd
City:
Jay
County: Santa Rosa
Phone: 251-227-3319 State: FL Zip: 32565
Well Data from File
Well Name & #: Well Type (see table): Latitude (N):
McDavid Lands #33-4A
Enhanced Oil Recovery (EOR)
30.98466084
Longitude (W):
API No. 0911320178 PA No. 311637
State Permit:
-87.16730932
OG_961A
Elevation (ft): Bottom BHA
Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing Otis WB @14912'
PBTD: 15670'
Other:
surface casing 10" @ 3617'
Upper BHA Baker FB-1 Packer
Total Depth (ft): 15715' Inner Casing Size (in):
Tubing Size (in):
Packer Depth (ft): @14816'
Inj. Zone: Open Hole; X Perforated; Top(ft) 15493' Bottom(ft): 15651' Max. Injection Pressure (psig)7: 500 psi N
Field Measurements and Observations
Latitude (N):
30.98465
Longitude (W): -87.16730
Elevation (ft):
EPA GPS ID: SX8123 Well Status (see table): AC If not Active, Reported Date Last Active:
Nature of Injected Fluid(s) if any:
Nitrogen (N) injection
General Condition of the Well Site:
Additional Notes & Comments: Maximum injection pressures are N 7500 psi, Produced Water (PW) 4400 psi
Notes & Comments (include discrepancies from database values): The well passed a mechanical integrity test on 6/29/2022.
15493' to 15511' (2SPF) 05/08/1980
Perforations (Smackover Formation)
15520' to 15551' (2SPF) 09/01/1979
15551' to 15593' (2SPF) 05/24/1980
Tubing gauge:
5100 psi
15580' to 15593' (4SPF) 01/29/1985
Production gauge
0 psi
Lower Perforations (Smackover Formation):
Surface gauge:
0 psi
15598' to 15619' (2SPF) 05/24/1980, 15599 to 15620' (4SPF) 01/29/1985, 15623' to 15645' (2SPF) 05/23/1980
15629' to 15651' (4SPF) 01/29/198S5ee reverse for additional observations, comments and photo log
UIC Inspector
UIC Inspector
Name:
Carl E. Weller
CARL WELLER
Signature: (Affiliate)
Digitally signed by CARL WELLER (Affiliate) Date: 2023.05.23 15:10:48 -04'00'
Name:
Carol Chen
CAROL CHEN Digitally signed by CAROL CHEN Date: 2023.05.17 16:39:26 -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 3 3 Year-Month-Day: 2 0 2 3 - 0 3 - 3 0
EPA Permit # (or RA): N O N E
Page 2 Of 2
Field Measurements and Observations (Cont.)
Photo Log
Photographer: Photo ID: Description: Photo ID: Description:
Carl E. Weller
EPA Camera ID:
SX8123
194
Time: 10:31 am Lat (N): 30.98465
Long (W)
sign posted directly on the injection well, close-up photo
195
Time: 10:31 am Lat (N): 30.98462
Long (W)
photo of the injection well, viewed several feet away
-87.16730 -87.16726
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:
UIC Inspector
Name: Signature:
Carl E. Weller
Digitally signed by CARL WELLER
CARL WELLER (Affiliate) (Affiliate)
Date: 2023.05.23 15:11:28 -04'00'
UIC Inspector
Name: Carol Chen
CAROL CHEN Date: 2023.05.17 16:39:54 -04'00' Digitally signed by CAROL CHEN
Signature:
Version 2018-04-18