Document omNDJQawRYLvpEy2odNdVoMQw

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 7 Year-Month-Day: 2 0 2 2 - 0 9 - 1 3 EPA Permit # (or RA): 5 8 1 Page 1 Of 2 Inspector(s): Jason Rose ___________________ (lead), Page Cirillo_____________________________ Start Time: 9:15 AM ____ ____________________________________, ____________________________________ End Time: 9:27 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 & #: St. Regis Paper Company #12-3 Well Type (see table): Enhanced Recovery (EOR) ________________________ State Permit: API # 0911320072 _________ Latitude (N): 30.833611 N______________ Longitude (W): -87.095556 W ___________ Elevation (ft): NA _________ Injection Method (check applicable): Casing Injector; Tubing & Packer; Cemented Injection Tubing PBTD 16,124' Other: __________________________________________________________________ Total Depth (ft): 16,410' ___ Inner Casing Size (in): 7" ______ Tubing Size (in): 3.5"______ Packer Depth (ft): 15,810' _ Inj. Zone: Open Hole; Perforated; Top(ft): 15,976'_ Bottom(ft): 16,066' ____ Max. Injection Pressure (psig): 2,500 psi Field Measurements and Observations Latitude (N): 30.867873 N______________ Longitude (W): -87.103575 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): ______________________________________________________ The well status is active. Injection pressure was at 1,600 psi. The site was clean and well-maintained. There was no evidence of leaks or excessive corrosion. Perfs (see well schematics): Perfs at 15976'-16066' 2SPF Total 184 shots 1_2_-_S_e_p_-_7_6_____________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 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 7 Year-Month-Day: 2 0 2 2 - 0 9 - 1 3 EPA Permit # (or RA): 5 8 1 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: 9:15 AM ____ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking west, St. Regis Paper Company #12-3 sign alongside access road. __________________________ Photo ID: 2 _______________Time: 9:18 AM ____ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking west, site overview showing well head, pressure gauges, valves, and as stairway. ____________ Photo ID: 3 _______________Time: 9:18 AM ____ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking south, closeup view of surface pressure gauge reading 0 psi._______________________________ Photo ID: 4 _______________Time: 9:18 AM ____ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking south, closeup view of production casing pressure gauge reading 0 psi. _____________________ Photo ID: 5 _______________Time: 9:19 AM ____ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking west, closeup view of line pressure gauge reading 1,600 psi. _______________________________ Photo ID: 6 _______________Time: 9:20 AM ____ Lat (N): NA __________________ Long (W): NA___________________ Description: Looking north, closeup view of internal pressure gauge reading 1,600 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 St. Regis Paper Company #12-3: September 13, 2022 Photograph 1: Looking west, St. Regis Paper Company #12-3 sign alongside access road. Page 1 of 6 Photograph 2: Looking west, site overview showing well head, pressure gauges, valves, and as stairway. Page 2 of 6 Photograph 3: Looking south, closeup view of surface pressure gauge reading 0 psi. Page 3 of 6 Photograph 4: Looking south, closeup view of production casing pressure gauge reading 0 psi. Page 4 of 6 Photograph 5: Looking west, closeup view of line pressure gauge reading 1,600 psi. Page 5 of 6 Photograph 6: Looking north, closeup view of internal pressure gauge reading 1,600 psi. Page 6 of 6