Document zQ9vBkj826VjVBxQZy0EKk5Xz
Inspection ID
Facility Contact Information
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 1 1 3 0 0 0 9
Year-Month-Day: 2 0 2 3 - 0 3 - 2 8 EPA Permit # (or RA): F L I 0 0 3 6
Page 1 Of 2
Carol Chen
Start Time: 1:07 pm
End Time: 1:11 pm
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:
Black Creek Energy, LLC
Email:
Mike Wetzel <mikew2859@gmail.com>
Facility Contact (if different):
Michael Wetzel
O/O Mailing Address: 140 Virginia Street, Suite 302
City:
Richmond
County:
N/A
State: FL
Zip:32565-9260
Phone: 601-431-5386 Phone: 850-324-6271
State: VA Zip: 23219
Well Name & #:
R. L. Moore #23-E
Well Type (see table): Enhanced Oil Recovery (EOR)
Latitude (N):
30.84106039
Longitude (W):
API No. 0911320121 PA No. 303041
State Permit:
-87.119759
OG_ 678
Elevation (ft):
Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing
PBTD: 16037' Total Depth (ft): 16070'
Other: srfc csg 9" @3895'
Inner Casing Size (in):
Tubing Size (in): Packer Depth (ft): cement plug on 1/17/2006 at: 15103'
Inj. Zone: Open Hole; X Perforated; Top(ft) 15928' Bottom(ft): 15976' Max. Injection Pressure (psig):2500 psi
Latitude (N):
30.840979
Longitude (W):
-87.112156
Elevation (ft):
EPA GPS ID: SX8123 Well Status (see table): TA If not Active, Reported Date Last Active:
Nature of Injected Fluid(s) if any:
General Condition of the Well Site:
Well Data from File
Field Measurements and Observations
Notes & Comments (include discrepancies from database values):
Temporarily Plugged and Abandoned (TPA) on 1/17/2006, TOC @ 15103'
Tubing gauge: Production gauge: Surface gauge:
0 psi 0 psi 0 psi
Injection well passed a mechanical integrity test on 8/24/2022
See reverse for additional observations, comments and photo log
UIC Inspector
UIC Inspector
Name: Carl E. Weller
Digitally signed by CARL WELLER
CARL WELLER (Affiliate) (Affiliate)
Signature:
Date: 2023.05.11 13:25:19 -04'00'
Name: Carol Chen
Signature: CAROL
CHEN
Digitally signed by CAROL CHEN Date: 2023.05.10 19:25:45 -04'00'
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 0 9 Year-Month-Day: 2 0 2 3 - 0 3 - 2 8
EPA Permit # (or RA): F L I 0 0 3 6
Page 2 Of 2
Field Measurements and Observations (Cont.)
Photo Log
Photographer: Photo ID: Description: Photo ID: Description:
Carl E. Weller
156
Time: 1:08 pm
157
Time: 1:11 pm
EPA Camera ID:
Lat (N): 30.84064 sign posted
Lat (N): 30.84098 photo of injection well
SX8123
Long (W)
-87.11205
Long (W)
-87.11215
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: Carl E. Weller
Digitally signed by CARL WELLER
CARL WELLER (Affiliate) (Affiliate)
Signature:
Date: 2023.05.11 13:26:05 -04'00'
UIC Inspector
Name: Carol Chen
CAROL CHEN Date: 2023.05.10 19:26:19 -04'00' Digitally signed by CAROL CHEN
Signature:
Version 2018-04-18