Document x6y3rJQ3J74qwNBqMrqb0B6
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): Carl E. Weller
_ (lead),
,
EPA Well ID#: F L S
Year-Month-Day: 2 0 2
EPA Permit # (or RA):
Carol Chen
1 1 3 0
3- 0 3
N O N E
Page 1
Start Time: End Time:
0 17 - 30
Of 2 1:18 pm 1:28 pm
Facility Contact Information
Facility Name: Maverick Natural Resources, LLC (Breitburn Operating LP)
Street Address: 5415 Oil Plant Rd
City: Jay
County: Santa Rosa
State: FL Zip: 32565
Nature of Business: oil and gas production
Facility Owner/Operator: Maverick Natural Resources, LLC
Phone: 850-675-1702
Email:
Facility Contact (if different): Al Jones, Plant Superintendent
O/O Mailing Address: 5415 Oil Plant Rd
City:
Jay
County: Santa Rosa
Phone: 251-227-3319 State: FL Zip: 32565
Well Data from File
Well Name & #:
Rosie L. Kersey #10-3
API No. 0911320040 PA No. 311588
Well Type (see table): Enhanced Oil Recovery (EOR)
State Permit:
OG_522
Latitude (N): 30.9581754
Longitude (W): -87.16654472
Elevation (ft):Top packer BHA
Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing Otis WB @ 15257'
PBTD: 15754'
Other:
surface casing 10" at 3678'
Bottom Packer BHA Arrowdrill B
Total Depth (ft): 15811' Inner Casing Size (in):
Tubing Size (in):
Packer Depth (ft): 15112'
Inj. Zone: Open Hole; X Perforated; Top(ft) 15469' Bottom(ft): 15646'
7500 N psi Max. Injection Pressure (psig):
Field Measurements and Observations
Latitude (N):
30.95824
Longitude (W):
-87.16650
Elevation (ft):
EPA GPS ID: SX8123 Well Status (see table): AC If not Active, Reported Date Last Active:
Nature of Injected Fluid(s) if any: Nitrogen (N) injection
General Condition of the Well Site:
Additional Notes & Comments: maximum injection pressures are N 7500 psi, Produced Water (PW) 4400 psi
Notes & Comments (include discrepancies from database values): The T-disk was not installed on the Nitrogen (N) flowline
Perforations (Smackover Formation):
and the line itself feels cold, clearly showing gas injection.
15469' to 15489' (GR-4SPF) 3/09/1974
T-disk was installed on the PW flowline, blocking injection.
15489' to 15527' (GR-4SPF) 11/14/2012
Tubing gauge:
5000 psi
15527' to 15547' (GR-4SPF) 3/09/1974
Production gauge
0 psi
15547 to 15586' (GR-4SPF) 11/14/2012
Surface gauge:
0 psi
15586' to 15646' (GR-4SPF) 5/04/1972
Injection well passed a mechanical integrity test on 5/12/2022.
Name: Signature:
See reverse for additional observations, comments and photo log
UIC Inspector
UIC Inspector
Carl E. Weller
Digitally signed by CARL WELLER
CARL WELLER (Affiliate) (Affiliate)
Date: 2023.05.23 15:07:57 -04'00'
Name:
Carol Chen
Signature: CAROL CHEN Date: 2023.05.17 13:59:44 -04'00' Digitally signed by CAROL CHEN
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)
EPA Well ID#: F L S 1 1 3 0 0 1 7 Year-Month-Day: 2 0 2 3 - 0 3 - 3 0
EPA Permit # (or RA): N O N E
Page 2 Of 2
Field Measurements and Observations (Cont.)
Photo Log
Photographer: Photo ID: Description: Photo ID: Description:
Carl E. Weller
EPA Camera ID:
206
Time: 1:18 pm Lat (N):
30.95836
sign posted to identify the injection well
207
Time: 1:20 pm Lat (N):
30.95824
close-up photo of the injection well
SX8123
Long (W)
Long (W)
-87.16708 -87.16650
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:
UIC Inspector
Name: Signature:
Carl E. Weller
Digitally signed by CARL WELLER
CARL WELLER (Affiliate) (Affiliate)
Date: 2023.05.23 15:08:26 -04'00'
UIC Inspector
Name: Carol Chen
CAROL CHEN Date: 2023.05.17 14:00:14 -04'00' Digitally signed by CAROL CHEN
Signature:
Version 2018-04-18