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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#: Year-Month-Day: 2 0 2 1 - 1 1 - 1 8 EPA Permit # (or RA): Page 1 Of 2 Inspector(s): _______C_a_rl_W__e_l_le_r__________________ (lead),________C_a_r_o_l_C_h_e_n__________________ Start Time: _3__:1_9__p_m___ ____________________________________, ____________________________________ End Time: _3__:2_5__p_m___ Facility Contact Information PETRO HARVESTER OPERATING COMPANY, LLC Facility Name: __________________________________________________________________________________________ 1107 W 6th St (office address) Street Address:_________________________________________________________________________________________ Laurel Jones City: _______________________________ County: _______________________________ MS State:________ Zip: __3_9_4_4__0__ Oil and gas extraction industry Nature of Business: _____________________________________________________________________________________ Facility Owner/Operator: ___P_E_T_R_O__H_A_R__V_E_S_T_E_R__O_P_E_R_A_T_I_N_G__C_O_M__P_A_N__Y_, _L_L_C_______ Phone: ___6_0_1_-_6_5_1_-_2_1_0_0__________ Email: ________k_e_r_ry_._a_ll_e_n_@_r_o_c_k_a_ll_e_n_e_r_g_y_.c_o_m________________________________________________________________ Facility Contact (if different): _____K__e_rr_y_A_l_le_n__, _S_r._O__p_e_ra__ti_o_n_s_M__a_n_a_g_e_r_____________ Phone: ___6_0_1_-_6_5_1_-_2_1_0_5__________ O/O Mailing Address: _____1_1_0_7__W__6_t_h_S_t__(o_f_fi_c_e_a_d__d_re_s_s_)______________________________________________________ City: _______L_a_u__re_l___________________ County: ______J_o_n_e_s_____________________ State:__M__S____ Zip: _3_9__4_4_0___ Well Data from File Well Name & #: ______L_a_u_r_e_l_F_ie_l_d_U__n_it_(_L_F_U_)_1_-_9__#_5__________________________________________________________ Well Type (see table): ___E_n_h__a_n_c_e_d_R_e__co__ve_r_y_,_U_I_C_C__la_s_s_I_I________________ State Permit: __A_P_I_#_2_3__0_6_7_2_0_3__6_2_-0__1_-0_0____ Latitude (N): ______3__1_.6_8__5_1_6____________ -89.14863 Longitude (W): ________________________ Elevation (ft): ___2_5_7_'_(G__r)___ Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing PBTD 12,646' Other: __________________________________________________________________ Total Depth (ft): __1_3_,_3_2_2_'__ Inner Casing Size (in): ___7_"____ Tubing Size (in):___2____"___ Packer Depth (ft): _1_2__,2_4_5_'_ Inj. Zone: Open Hole; X Perforated; Top(ft) _1__2_,2_7__7_ Bottom(ft): _1_2__,5_6_0__' ___ Max. Injection Pressure (psig): 2_,_8_0_0__p_s_i Field Measurements and Observations Latitude (N): ________3_1_.6__8_5_4_1___________ Longitude (W): ______-_8_9_._1_4_8_8_8__________ Elevation (ft): ____________ EPA GPS ID: __S_X_8_1_2_3__ Well Status (see table): _____IN____ If not Active, Reported Date Last Active: __3__/_1_/_2_0_2__0_______ Nature of Injected Fluid(s) if any: _____P_r_o_d_u_c_e_d__f_lu_i_d_s________________________________________________________ General Condition of the Well Site: _______________N_A_________________________________________________________ _____________________________________________________________________________________________________ Tubing gauge: 0 psi, Annulus gauge: 0 psi Notes & Comments (include discrepancies from database values): ______________________________________________________ Perforations given by on-site field hand: _____________________________________________________________________________________________________ ______________________1_2__,2__7_7_'_t_o__1_2_,_3_0_1__' ____1_2_,_4_5_3__' _to__1_2__,4_6__6_'________________________________________ ______________________1__2_,_3_2_0_'_t_o__1_2_,_3_2__6_' ____1_2_,_5_2__1_' _to__1_2__,5__3_0_'________________________________________ 12,347' to 12,353' 12,545' to 12,560' _____________________________________________________________________________________________________ ______________________1_2__,3__9_7_'_t_o__1_2_,_4_0_3__' _____________________________________________________________ ______________________1_2__,4_2__9_'_t_o_1__2_,4__3_4_'______________________________________________________________ See reverse for additional observations, comments and photo log Owner/Operator Representative (Optional) UIC Inspector Name:_______________________________________________ Name: ________C_a__rl_W__e_l_le__r____________________________ Signature: ___________________________________________ Signature: ___________________________________________ Version 2018-04-18 CAROL CHEN Digitally signed by CAROL CHEN Date: 2022.01.13 18:04:42 -05'00' Inspector Carol Chen's signature: _________________________ 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#: Year-Month-Day: 2 0 2 1 - 1 1 - 1 8 EPA Permit # (or RA): Page 2 Of 2 (Cont) ______L_a_u_r_e_l _F_ie_l_d_U_n_i_t_(_L_F_U_)_1_-_9_#__5__________________________________________________________________ _____________________________________________________________________________________________________ __T_e__a_m_'_s__o_b_s_e_r_v_a_t_io_n__s_/_c_o_m__m_e_n__ts_:__W_e__I_n_s_p_e_c_t_e_d__8__w_e_l_ls__th__a_t_d_a_y_,_w__it_h__a__to_t_a_l_o_f__9__p_e_o_p_l_e_._4__fr_o_m___P_e_t_r_o_____ ______H_a_r_v_e_s_t_e_r_,_2__fr_o_m___M_S__O_G__B_a__n_d__E_P_A_._A_l_l_t_h_e__lo_c_a_t_i_o_n_s__w_e__w_e_r_e__o_n__d_u_r_in__g_I_n_s_p_e_c_t_io__n_,_w_e__re__f_e_n_c_e_s__a_n_d____ ______g_a_t_e_d_w__it_h__C_h_a_i_n__li_n_k_,_t_a_l_l _p_la_n__k_o_r__v_e_r_y_s_t_y_li_s_h__b_ri_c_k__fe_n__c_in_g_.__A_ll_t_h_e__P_u_m__p_i_n_g__U_n_i_ts__a_n_d__I_n_je_c__ti_o_n__P_u_m__p_s_ _____w__e_r_e_o__f _h_i_g_h_q__u_a_li_t_y_a_n_d__o_p__e_ra__te_d__a_l_m__o_s_t_s_i_le_n_t_l_y_. _E_m__p_lo_y_e__e_s_w__e_r_e_p__o_li_te__. _L_o_c_a_t_io_n__s_s_e_e_m__e_d__t_o__b_e_k__e_p__ _____c_l_e_a_n__a_n_d__o_r_g_a_n_i_z_e_d_._____________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ (TA status: inactive 2 years or more. IN status: inactive less than 2 years. PBTD: Plug back total depth - not total well depth) _____________________________________________________________________________________________________ Photo Log Carl Weller Photographer: ______________________________________EPA Camera ID: ____S_X__8_1_2_3____________________________ Photo ID: _____1__1_9_________Time: ___3_:0_5__p_m____ Lat (N): ______3_1_._6_8_4_8_2________ Long (W) _______-8_9__.1_4_9__4_5_______ Description: ________l_o_c_a_ti_o_n_o_v_e_r_v_ie_w_________A_lt_it_u_d_e__1_0_5____________________________________________________ Photo ID: _____1_2__0_________Time: __3__:1_9__p_m____ Lat (N): 31.68541 _____________________ Long (W) _______-_8_9_._1_4_8_8_8_______ well site Altitude 105 Description: ___________________________________________________________________________________________ Photo ID: _________________Time: ____________ Lat (N): _____________________ Long (W) ______________________ Description: ___________________________________________________________________________________________ Photo ID: _________________Time: ____________ Lat (N): _____________________ Long (W) ______________________ Description: ___________________________________________________________________________________________ Photo ID: _________________Time: ____________ Lat (N): _____________________ Long (W) ______________________ Description: ___________________________________________________________________________________________ Photo ID: _________________Time: ____________ Lat (N): _____________________ Long (W) ______________________ Description: ___________________________________________________________________________________________ Owner/Operator Representative (Optional) UIC Inspector Carl Weller Name:_______________________________________________ Name: ______________________________________________ Signature: ___________________________________________ Signature: ___________________________________________ Version 2018-04-18 CAROL CHEN Digitally signed by CAROL CHEN Date: 2022.01.13 18:05:27 -05'00' Inspector Carol Chen's signature: _________________________