Document ombG1meg59yZnw0X869jMMBDr

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): Carol Chen _ (lead), , EPA Well ID#: K Y S Year-Month-Day: 2 0 2 EPA Permit # (or RA): Lonnie Dorn 0650124 4 -10 -22 Page 1 Of 2 Start Time: 2:55 pm End Time: 3:11 am Facility Contact Information Facility Name: Street Address: Wagner Farm 125 McCemetery Road City: Stanton County: Estill Nature of Business: oil production Facility Owner/Operator: Douglas A. Wagner State: KY Zip: 40380 Phone: 817-658-3066 Email: da.wagner@att.net Facility Contact (if different): O/O Mailing Address: 9013 Thornway Drive City: North Richland Hills County: Phone: State: TX Zip: 76182 Well Data from File Well Name & #: WAGNER FARM #2 Well Type (see table): Class II - Unauthorized Injection Well Latitude (N): 37.73112 Longitude (W): -83.76787 State Permit: Elevation (ft): Injection Method (check applicable): Casing Injector; Tubing & Packer; Cemented Injection Tubing Total Depth (ft): Other: Inner Casing Size (in): 7" Tubing Size (in): Packer Depth (ft): Inj. Zone: Open Hole; Perforated; Top(ft) Bottom(ft): Max. Injection Pressure (psig): Latitude (N): 37.73101 Longitude (W): -83.767765 Elevation (ft): EPA GPS ID: S75332 Well Status (see table): AN If not Active, Reported Date Last Active: 9/27/2012 Nature of Injected Fluid(s) if any: General Condition of the Well Site: Notes & Comments (include discrepancies from database values): In the field, there are trees, bushes, and undergrowth. No sign of an injection well. AN Status Code: Plugged and Abandoned without approval Field Measurements and Observations See reverse for additional observations, comments and photo log UIC Inspector UIC Inspector Name: Carol Chen CAROL CHEN Signature: Digitally signed by CAROL CHEN Date: 2025.02.11 10:44:08 -05'00' Name: 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) WAGNER FARM #2 EPA Well ID#: K Y S 0 6 5 0 1 2 4 Year-Month-Day: 2 0 2 4 - 1 0 - 2 2 EPA Permit # (or RA): Page 2 Of 2 Field Measurements and Observations (Cont.) Photo ID: RIMG0200 Time: 2:58 pm Lat(N): 000 Description: Trees, bushes, and undergrowth, photo 1 Long (W) 000 Photo Log Photographer: Carol Chen EPA Camera ID: Photo ID: RIMG0201 Time: 2:58 pm Lat (N): 37.73101 Description: Trees, bushes, and undergrowth, photo 2 Photo ID: RIMG0202 Time: 2:59 pm Lat (N): 37.731101 Description: Trees, bushes, and undergrowth, photo 2 Photo ID: RIMG0203 Time: 2:59 pm Lat (N): 37.731098 Description: Trees, bushes, and undergrowth, photo 3 Photo ID: RIMG0204 Time: 3:10 pm Lat (N): 000 Description: Trees, bushes, and undergrowth, photo 4 Photo ID: RIMG0205 Time: 3:11 pm Lat (N): 000 Description: Trees, bushes, and undergrowth, photo 5 Photo ID: RIMG0206 Time: 3:11 pm Lat (N): 000 Description: Trees, bushes, and undergrowth, photo 6 S75332 Long (W) Long (W) Long (W) Long (W) Long (W) Long (W) -83.767765 -83.767617 -83.767603 000 000 000 UIC Inspector UIC Inspector Name: Signature: Name: Carol Chen Signature: CAROL CHEN Digitally signed by CAROL CHEN Date: 2025.02.11 10:44:33 -05'00' Version 2018-04-18