Document xdL8KVBeKN6D799drqEEjYx0Q
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#: F L S Year-Month-Day: 2 0 2
EPA Permit # (or RA):
Carla Foy
1 1 30 4 -05 F L I 0
Page 1
Start Time:
End Time:
06 7 - 0 1 0 3 4 Of 2
1:19 pm
1:23 pm
Facility Contact Information
Facility Name: Street Address: City:
Black Creek Energy, LLC
4940 Blackjack Plant Rd.
Jay
County:
Santa Rosa
Nature of Business:
Oil and gas production
Facility Owner/Operator: Email:
Harris D. Butler, III harris.butler@butlerroyals.com
Facility Contact (if different):
O/O Mailing Address: 140 Virginia Street, Suite 302
City:
Richmond
County:
N/A
State: FL
Zip:32565-9260
Phone: (804)-334-0527
Phone:
State: VA Zip: 23219
Well Data from File
Well Name & #: J. H. Wells #23
Well Type (see table):
Enhanced Oil Recovery (EOR)
Latitude (N): 30.84893258
Longitude (W):
API No. 0911320130 PA No. 30253
State Permit:
-87.12033323
OG_ 693
Elevation (ft):
Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing
PBTD: 16025'
Other: srfc csg 9" @3967'
Total Depth (ft): 16025' Inner Casing Size (in):
Tubing Size (in):
Packer Depth (ft): 15040'
Inj. Zone: Open Hole; X Perforated; Top(ft) 15912' Bottom(ft): 15941' Max. Injection Pressure (psig):2500 psi
Latitude (N): No GPS 000
Longitude (W): No GPS 000
Elevation (ft):
EPA GPS ID: SX8123 Well Status (see table): TA If not Active, Reported Date Last Active: unknown
Nature of Injected Fluid(s) if any:
General Condition of the Well Site:
Field Measurements and Observations
Notes & Comments (include discrepancies from database values):
This well is inactive, temporarily abandoned, with partial plugging on 7/25/06.
Tubing gauge:
0 psi
Production gauge:
0 psi
Surface gauge:
0 psi
See reverse for additional observations, comments and photo log
U IC Inspector
UIC Inspector
Name: Carol Chen
Name:
Signature: CAROL CHEN
Digitally signed by CAROL CHEN Date: 2024.06.24 11:15:42 -04'00'
Signature:
UIC Inspector:
UIC Inspector:
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)
J. H. Wells #23
EPA Well ID#: F L S 1 1 3 0 0 6 7 Year-Month-Day: 2 0 2 4 - 0 5 - 0 1
EPA Permit # (or RA): F L I 0 0 3 4 Page 2 Of 2
Field Measurements and Observations (Cont.)
Photo Log
Photographer: Carol Chen
EPA Camera ID:
SC8284
Photo ID: DSCN1431 Time: 1:19 pm Lat (N): No GPS 000
Long (W)
Description: well identification sign at property entrance
Photo ID: DSCN1432 Time: 1:21 pm Lat (N): No GPS 000
Long (W)
Description: tubing gauge, production gauge, and surface gauge, all read 0 psi
No GPS 000 No GPS 000
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:
U IC Inspector)
UIC Inspector
Name:
Carol Chen
Name:
Signature: CAROL CHEN
Digitally signed by CAROL CHEN Date: 2024.06.24 11:16:07 -04'00'
Signature:
Version 2018-04-18
UIC Inspector:
UIC Inspector: