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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 EPA Well ID#: K Y S 1 5 3 0 2 8 0 Year-Month-Day: 2 0 2 4 - 1 0 - 2 2 EPA Permit # (or RA): R A Phone: (404)562-9424 Page 1 Of 2 Inspector(s): _C_a__ro__l _C_h_e__n______________________ (lead),___L_o__n_n_i_e__D_o__r_n___________________ Start Time1: _2_:_0__1__a_m__ ____________________________________, ____________________________________ End Time1: _2_:_0_4___a_m__ Facility Contact Information Facility Name:___S__l_o_n_e__E__n_e_r_g__y_,_L_L__C____________________________________________________________________ Street Address:__8_9__6_6__K__Y__R__T__4_0__W__e__s_t_, _P_._O__._B__o_x__2_2__0__________________________________________________ City: _____ Oil Springs_______________ County: _____M__a_g_o_f_fi_n___________________ State:__K_Y_____ Zip: _4_1__4_6_5___ Nature of Business: ___o__il_p__r_o_d_u__c_ti_o_n_____________________________________________________________________ Facility Owner/Operator: __M__r_. _S__._C__h_r_i_s__S__lo__n_e_,__P__E_______________________ Phone: _6_0__6_._2_9__7_._5_3__3_0__w__o__r_k__ Email: ________c_h__ri_s_s_lo__n_e_@__s_l_o_n_e_e__n_e_r_g_y_._c_o_m_____________________________________________________________ Facility Contact (if different): ________________________________________________ Phone: _6_0__6_._2_2_5__.2__2_0_6__c_e__ll_____ O/O Mailing Address: ____________________________________________________________________________________ City: _______________________________ County: _______________________________ State:________ Zip: _________ Well Data from File Well Name & #: ________J_A__C_K___H__U__N_L__E__Y__#__W__-_5_________________________________________________________ Well Type (see table): _C__la_s__s_I_I_-_R_,__E_n__h_a_n__c_e_d__O__il__R_e__c_o_v_e__ry__(_E__O__R_)__ State Permit: __________________________ Latitude (N): ______3_7__.8__2_2_5__8___________ Longitude (W): _____-_8_3_._0_3__3_6_3__________ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; XTubing & Packer; Cemented Injection Tubing Other: __4____"__p_r_o__d_u__c_t_io__n__c_a__s_in__g_______________________________________ Total Depth (ft): __________ Inner Casing Size (in): _2_____"__ Tubing Size (in):____1_"_____ Packer Depth (ft): ________ Inj. Zone: Open Hole; Perforated; Top(ft) ________ Bottom(ft): ___________ Max. Injection Pressure (psig): ________ Field Measurements and Observations Latitude (N): _____0_0__0__________________ Longitude (W): ____0__0_0_________________ Elevation (ft): ____________ EPA GPS ID: _S__7_5_3__3_2_ Well Status (see table): __A___N____ If not Active, Reported Date Last Active: _u_n__k_n__o_w__n________ Nature of Injected Fluid(s) if any: __________________________________________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): ______________________________________________________ _____________________________________________________________________________________________________ N__o___w__e_l_l_c_a__p__is___fo__u_n__d__i_n__t_h__is__e__m__p__t_y_,_g__r_a_s__s_y__f_i_e_l_d__, _n__o_r__a_n__y__p__r_o_d__u_c__ti_o__n_/_s_u__r_fa__c_e___c_a__s_i_n_g__s_. _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ See reverse for additional observations, comments and photo log 8,&,QVSHFWRU UIC Inspector Carol Chen Name:______________________________________________ Name: ______________________________________________ Signature: _C_A__R__O__L__C_H__E__N_______D_a_te_: _20_2_4._12_.1_0_1_8:_12_:4_0_-0_5_'00_' ___ Signature: ___________________________________________ 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#: K Y S 1 5 3 0 2 Year-Month-Day: 2 0 2 4 - 1 0 - EPA Permit # (or RA): R A Page 2 Of 80 22 2 (Cont) ________________________________________________________________________________________________ ___________J__A_C__K___H__U__N__L__E_Y___#__W__-_5_____________C_l_a_s_s__I_I_-R__,_E__n_h__a_n_c_e__d__O__il_R__e_c__o_v_e_r_y__(_E_O__R__)_________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Photo Log Photographer:_C_a__ro__l _C_h_e__n___________________________EPA Camera ID: _S__7_5_3__3_2______________________________ Photo ID: _R__IM___G__0_1_9__4_____Time: _1__2_:_0_1__a__m__ Lat (N): _____0__0__0____________ Long (W) _______0_0__0____________ Description: ___g__r_a_s__s__y__f_i_e_l_d__,__v_e__g__e__ta__t_i_o__n_,__p__h__o_t_o___1_____________________________________________ Photo ID: _R__IM__G__0_1__9_5______Time: _1_2__:0__1_a__m___ Lat (N): _____0__0__0____________ Long (W) _______0__0__0___________ Description: __g__r_a__s_s__y__f_i_e__ld__,__v_e__g__e__t_a_t_i_o__n_,__p__h__o_t_o___2______________________________________________ Photo ID: _R__IM___G__0_1_9__6_____Time: _1_2__:0__2_a__m___ Lat (N): ______0__0_0____________ Long (W) _______0__0__0___________ Description: __g__r_a__s_s__y__f_i_e__l_d_,__v__e_g__e__t_a__ti_o__n__,_p__h__o__t_o__3______________________________________________ Photo ID: _________________Time: ____________ Lat (N): _____________________ Long (W) ______________________ Description: ___________________________________________________________________________________________ Photo ID: _________________Time: ____________ Lat (N): _____________________ Long (W) ______________________ Description: ___________________________________________________________________________________________ Photo ID: _________________Time: ____________ Lat (N): _____________________ Long (W) ______________________ Description: ___________________________________________________________________________________________ 8,&,QVSHFWRU UIC Inspector Carol Chen Name:______________________________________________ Name: ______________________________________________ Signature: _C_A__R__O_L__C__H__E_N________D_a_te_: 2_0_24_.1_2_.1_0 1_8_:1_3:_08_-_05_'0_0'____ Signature: ___________________________________________ Digitally signed by CAROL CHEN Version 2018-04-18