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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#: F L S 1 1 3 0 0 0 8 Year-Month-Day: 2 0 2 2 - 0 9 - 1 3 EPA Permit # (or RA): 6 2 3 Page 1 Of 2 Inspector(s): Jason Rose ___________________ (lead), Page Cirillo_____________________________ Start Time: 10:57 AM___ ____________________________________, ____________________________________ End Time: 11:05 AM ___ Facility Contact Information Facility Name: Blackjack Plant ____________________________________________________________________________ Street Address: 4940 Blackjack Plant Road _________________________________________________________________ City: Jay ____________________________ County: Santa Rosa _____________________ State: FL _____ Zip: 32535 ___ Nature of Business: Oil and gas production__________________________________________________________________ Facility Owner/Operator: Black Creek Energy, LLC ____________________________ Phone: (601) 431-5386 __________ Email: harris.butler@butlerroyals.com ______________________________________________________________________ Facility Contact (if different): Michael Wetzel ___________________________________ Phone: (850) 324-6271 __________ O/O Mailing Address: 140 Virginia Street, Suite 402 __________________________________________________________ City: Richmond ______________________ County: NA_____________________________ State: VA _____ Zip: 23209 ___ Well Data from File Well Name & #: W.W. Foskett #24-3 Well Type (see table): Enhanced Recovery (EOR) ________________________ State Permit: API # 0911320097 _________ Latitude (N): 30.841148N______________ Longitude (W): -87.101548W ___________ Elevation (ft): NA _________ Injection Method (check applicable): Casing Injector; Tubing & Packer; Cemented Injection Tubing PBTD 15,991' Other: __________________________________________________________________ Total Depth (ft): 16,030' ___ Inner Casing Size (in): 7" ______ Tubing Size (in): 3.5" _____ Packer Depth (ft): 15,700' Inj. Zone: Open Hole; Perforated; Top(ft): 15,859'_ Bottom(ft): 15,940' ____ Max. Injection Pressure (psig): 2,500 psi Latitude (N): 30.841063 N______________ Longitude (W): -87.101561 W ___________ Elevation (ft): NA _________ EPA GPS ID: PG No. 3358766066 Well Status (see table): AC If not Active, Reported Date Last Active: ___________________ Nature of Injected Fluid(s) if any: __________________________________________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): ______________________________________________________ Field Measurements and Observations The internal pressure gauge reading was 1,700 psi. The site was clean and well-maintained. There was no evidence of leaks or excessive corrosion. Perfs (see well schematics): Re-perfed: 15,890'-940' GR 2SPF (11/'80) Re-perfed: 15859' - 889' GR 4SPF (11/26/'77) P_e_rf_s_: _1_5_8_6__5_'-_9_3_5_'_G_R__(_0_8_/_1_9_/_'_7_4_)________________________________________________________________________ _____________________________________________________________________________________________________ See reverse for additional observations, comments and photo log Owner/Operator Representative (Optional) UIC Inspector Name: Cliff Emmons ___________________________________ Name: Jason Rose ____________________________________ Signature & Date: see attached field notes ________________ Signature & Date:__________________________1_0_/_2__6_/_2_2___ 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 0 8 Year-Month-Day: 2 0 2 2 - 0 9 - 1 3 EPA Permit # (or RA): 6 2 3 Page 2 Of 2 (Cont) ________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Photo Log Photographer: Jason Rose ____________________________EPA Camera ID: PG camera ID no. 14 S/N:31029537 _______ Photo ID: 1 _______________Time: 10:58 AM ___ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking west, W.W. Foskett #24-3 sign alongside access road. ____________________________________ Photo ID: 2 _______________Time: 10:59 AM ___ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking east, site overview, showing well head, pressure gauges, valves, and access stairs. ___________ Photo ID: 3 _______________Time: 11:00 AM ___ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking north, closeup view of surface pressure gauge reading 0 psi. _______________________________ Photo ID: 4 _______________Time: 11:01 AM ___ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking north, closeup view of production casing pressure gauge reading 0 psi. _____________________ Photo ID: 5 _______________Time: 11:01 AM ___ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking north, view of incoming line pressure gauge reading 1,700 psi. _____________________________ Photo ID: 6 _______________Time: 11:01 AM ___ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking east, view of internal presure gauge reading 1,700 psi.____________________________________ Owner/Operator Representative (Optional) UIC Inspector Name: Cliff Emmons ___________________________________ Name: Jason Rose ____________________________________ Signature & Date: see attached field notes ________________ Signature & Date:__________________________1_0_/_2_6__/2__2___ Version 2018-04-18 Site Photographs W.W. Foskett #24-3 September 13, 2022 Photograph 1: Looking west, W.W. Foskett #24-3 sign alongside access road. Photograph 2: Looking east, site overview, showing well head, pressure gauges, valves, and access stairs. Photograph 3: Looking north, closeup view of surface pressure gauge reading 0 psi. Photograph 4: Looking north, closeup view of production casing pressure gauge reading 0 psi. Photograph 5: Looking north, view of incoming line pressure gauge reading 1,700 psi. Photograph 6: Looking east, view of internal presure gauge reading 1,700 psi.