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X 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 1 5 3 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_ie__D_o_r_n____________________ Start Time:1_2__:0__7__p_m__ ____________________________________, ____________________________________ End Time1: _2_:_1_0___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: ___O__il_S__p_r_i_n_g_s_______ County:______M__a_g_o_f_f_in__________________ State:__K_Y_____ Zip: 41238_ Nature of Business: ___o__il_p__r_o_d_u__c_ti_o_n_____________________________________________________________________ Facility Owner/Operator: _____M__r.__S_.__C_h__ri_s__S_l_o_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___-_2_4________________________________________________________ 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__1_6_4___________ Longitude (W): _____-_8__3_._0_3_4__0_3_________ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; Tubing & Packer; Cemented Injection Tubing Other: ______6____"________________________________________________________ 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): ___3_7__.8_2__1_6_9__3_____________ Longitude (W): ____-8__3_._0_3_4__0_3_8__________ Elevation (ft): ____________ EPA GPS ID: S__7__5_3__3_2_ Well Status (see table): ____T_A____ 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): ______________________________________________________ _____________________________________________________________________________________________________ _T__h_e__i_n__je__c_t_i_o_n__w__e__l_l _i_s__d_i_s_c__o_n__n_e__c_t_e__d__f_r_o_m___t_h__e__in__j_e_c__ti_o__n__li_n__e_.__T_h__e__w__e__ll_c_a__p__s__h_o__w__s________ _s_o__m__e__c__o_r_r_o_s__io__n__. _________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 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_1_1_1:_15_:0_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 1 Year-Month-Day: 2 0 2 4 - 1 0 - EPA Permit # (or RA): R A Page 2 Of 53 22 2 (Cont) ________________________________________________________________________________________________ _____________J__A__C__K__H__U__N__L__E__Y__#__W___-2__4____________C__la__s_s__II_-_R__, _E_n__h_a_n__c_e_d__O__i_l _R__e_c_o_v__e_r_y__(E__O__R__)_____ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Photo Log Photographer:____C__a__r_o_l_C__h__e_n______________________EPA Camera ID: ___S__7_5__3_3_2____________________________ Photo ID: _R__IM___G__0_1_9__7_____Time: _1_2__:0__8__p_m___ Lat (N): ___3__7_._8_2__1_7__2_8_______ Long (W) __-8__3_._0_3__4_1__0_5_________ Description: _in__j_e_c__t_io__n__w___e_l_l__________________________________________________________________________ Photo ID: _R__IM__G__0_1__9_8______Time: _1_2__:0__8_p__m___ Lat (N): ____3_7_._8_2__1_6_9__3_______ Long (W) __-8__3_._0_3_4__0_3_8__________ Description: _in__j_e_c__t_io__n__w__e__l_l,__s__li_g__h_t_l_y__c__lo__s_e__r_______________________________________________________ Photo ID: _R_I_M__G__0_1_9_9_______Time: _1_2__:0__9_p__m___ Lat (N): ____3_7__.8__2_1_7__5_6_______ Long (W) __-8__3_._0_3_3__9_6_3__________ Description: _i_n_j_e_c__ti_o__n__w__e_l_l_,_f_a_r_t_h__e_r__b__a_c_k____________________________________________________________ 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_1 1_1_:1_5:_22_-_05_'0_0'____ Signature: ___________________________________________ Digitally signed by CAROL CHEN Version 2018-04-18