Document pBbDXjayY2m1exb8O7K9ygg8d

DownloadSearchable PDFRandom document
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 Year-Month-Day: 2 0 2 4 - 0 5 - EPA Permit # (or RA): Page 1 Of 1 2 0 1 2 Inspector(s): ______C_a__r_o_l_C_h__e_n__________________ (lead), ______C__a_r_la__F__o_y____________________ Start Time: _1_0_:_1_6__a__m__ ____________________________________ , ______________________________________ End Time: _1_0__:2__8__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_____(_B_r_e_i_tb__u_r_n__O_p__e_r_a_t_in_g__L_P__)___________________________ 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 Well Name & #: ___W__._W__._J_o__h_n_s_o__n_E__t_a_l_#_5__-5__A___A__P_I_N__o_._0__9_1__1_3_2__0_1__8_1_0__1_______P_A__N_o__. _3_1__1_6__3_9____________ Well Type (see table): ___E_n__h_a_n__c_e_d__O_i_l_R__e_c_o_v_e__ry__(_E_O_R__)______________ State Permit: ____O__G___9__7_3__A_____________ Latitude (N): ____3_0__.9__7_0__1_1_3__8_9_________ Longitude (W): ____-_8_7__.1__5_3_7__8_0__5_6______ Elevation (ft): ___2_4__6_'_____ Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing Baker Otis "WB" 15220' PBTD: 15731' Other: ___S_u_r_f_a_c_e_c_a_s_i_n_g_1_0__3_/_4_"_t_o__3_7_8_5_'___________________H_a_ll_ib_u_rt_o_n_"_B_W_B_"_1_5058' Halliburton Total Depth (ft): _1__5_8__0_0_'__ Inner Casing Size (in): 7__5__/_8_"__ Tubing Size (in):__4__1_/_2__"__ Packer Depth (ft): _13,998' 7,500psi gas Inj. Zone: Open Hole; X Perforated; Top(ft) _1_5_5__1_0__' Bottom(ft): _1_5_7__2_9__' Max. Injection Pressure (psig): 4_,4__0_0_p_s_iS_W Field Measurements and Observations Latitude (N): ____N__o__G_P_S__0__0_0___________ Longitude (W): ___N__o__G_P_S__0__0_0__________ Elevation (ft): ____________ EPA GPS ID: _S_C__8_2_8__4_ AC Well Status (see table): _________ If not Active, Reported Date Last Active: __________________ Nature of Injected Fluid(s) if any: ________P_r_o_d_u_c_e_d__W__a_t_e_r_s_(_P_W__)______________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): ______________________________________________________ ____________________________________________E_m__p_l_o_y_e_e_i_s__b_le_e__d_in_g__o_f_f_f_lu_i_d_s_:__B_e_f_o_r_e__________A_f_te__r ________ T-skillet was placed on the Nitrogen (N) line to Tubing Gauge: 2600 psi 2600 psi _____________________________________________________________________________________________________ s_t_o_p__g_a_s__in_j_e_c_t_io_n_.__T_h_is__w_e_l_l_is__p_r_e_s_e_n_t_l_y_i_n_je_c_t_i_n_g_______P_r_o_d_u_c_t_i_o_n__G_a_u_g_e__: _____1_3__5__p_s_i _________0__p_s_i________ PW fluids, running hot (thermal). Surface Gauge: 0 psi 0 psi _____________________________________________________________________________________________________ ___________________________________________________F_l_o_w__L_i_n_e_G__a_u_g_e_:_______0__p_s_i____________0__p_s_i________ DANGER sign: HS May be Present...Hazardous Operations...Keep Out... _____________________________________________________________________________________________________ See reverse for additional observations, comments and photo log UIC Inspector UIC Inspector Name:______________________________________________ Name: ____C__a_r_o_l_C__h_e_n________________________________ Signature: ___________________________________________ Signature: _C_A__R__O__L__C__H_E__N_______D_a_te_: _20_2_4._06_.2_0_2_1:_43_:5_0_-0_4_'0_0'___ 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 Year-Month-Day: 2 0 S 1 2 4 1 3 - 0 0 0 5- 1 2 0 1 EPA Permit # (or RA): Page 2 Of 2 (Cont) ________________________________________________________________________________________________ ______W__. _W__._J_o_h_n__s_o_n__E_t_a_l__#_5_-_5_A__________O_G____9_7__3_A_________________A__P_I_N__o_._0__9_1_1__3_2__0_1_8__1_0__1____________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 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_3__8_4_____Time: _1_0__:2_0__a_m____ Lat (N): ___N__o__G_P_S__0__0_0_______ Long (W) ____N_o__G__P_S__0__0_0_______ Description: _In__je_c_t_io__n_w__e_ll_,_id__e_n_t_if_ic_a_t_i_o_n_s__ig_n_,_D__A_N_G__E_R__s_ig_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_r_a_ti_o_n_s_._.._____ Photo ID: __D_S__C_N__1_3__8_5_____Time: _1_0_:_2_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_je__c_ti_o_n__tu__b_in__g_g_a_u__g_e_r_e_a_d__s_2__6_0_0__p_s_i_______________________________________________________ Photo ID: __D_S__C_N__1_3__8_6_____Time: _1_0_:_2_1__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__1_3_5__p_s_i_a_n__d_s_u__rf_a_c_e__g_a_u_g_e__r_e_a_d_s__0__p_s_i_______________________________ Photo ID: __D__S_C_N__1_3__8_7_____Time: _1_0_:_2_2_a__m____ Lat (N): ___N_o__G__P_S__0_0__0_______ Long (W) ___N__o__G_P_S__0__0_0________ Description: _T_-_s_k_i_ll_e_t_i_s_p_l_a_c_e_d__o_n__t_h_e_N__it_r_o_g_e_n__(_N__)_g_a_s__l_in_e__t_o_h__a_lt_g__a_s_i_n_j_e_c_ti_o_n_____________________________ Photo ID: __D__S_C_N__1_3__8_8_____Time: _1_0__:2__6__a_m___ Lat (N): __N__o__G_P__S__0_0__0_______ Long (W) ___N__o_G__P_S__0__0_0________ Description: __in__je_c_t_io__n_t_u_b_i_n_g__g_a_u_g_e__r_e_a_d_s__2_6_0__0__p_s_i ______________________________________________________ Photo ID: __D__S_C__N_1__3_8_9_____Time: _1__0_:_2_8__a_m___ Lat (N): __N__o_G__P_S__0__0_0________ Long (W) ___N_o__G__P_S__0__0_0________ Description: __n_o_w__p_r_o_d_u_c_t_i_o_n__g_a_u_g_e__re__a_d_s__0_p__s_i _a_n_d__s_u_r_fa__c_e_g_a__u_g_e__re_a__d_s_0__p_s_i______________________________ UIC Inspector Name:______________________________________________ UIC Inspector Carol Chen Name: ______________________________________________ Signature: ___________________________________________ CAROL CHEN Digitally signed by CAROL CHEN Date: 2024.06.20 21:44:15 -04'00' Signature: ___________________________________________ Version 2018-04-18