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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 EPA Well ID#: K Y S 0 9 1 0 1 1 9 Year-Month-Day: 2 0 2 4 - 0 2 - 2 1 EPA Permit # (or RA): K Y A 0 3 6 2 Phone: (404)562-9424 Page 1 Of 2 Inspector(s): _______C_a__r_o_l_C_h__e_n________________ (lead),______B__r_ia_n__n_a__L_a_P__a_p_a_____________ Start Time: _1__:5__5__p_m__ ____________________________________, ____________________________________ End Time: _1__:5__7__p_m__ Facility Contact Information Facility Name:______W__e__s_t_K__e_n_t_u_c_k__y_E_n__e_r_g_y__R_e_s_o__u_r_c_e_s_,_L__L_C______________________________________________ Street Address:______3_8_3__0__V_i_n_c_e_n__t_S_t_a_t_i_o_n__D_r_i_v_e_________________________________________________________ City: ____O__w_e_n__s_b_o_r_o_________________ County: ______H_a_n__c_o_c_k__________________ State:___K_Y____ Zip: _4__2_3__0_3__ Nature of Business: ________O__il__a_n_d__g_a__s_e__x_tr_a_c_t_i_o_n________________________________________________________ Facility Owner/Operator: ____W__e_s_t__K_e_n__tu__c_k_y__E_n_e__rg__y_R__e_s_o_u__rc_e__s_,_L_L_C________ Phone: ____2__7_0_-_9__2_6_-_1_6__8_9______ Email: ______________G__le__n_R__i_d_g_e_s_:__2_7_0__-3__1_6__-7__4_8_7_______________________________________________________ Facility Contact (if different): _____V__in__c_e_n_t__B_._H__a_y_d_e__n_,_J_r_.,__M__a_n_a_g__e_r___________ Phone: ____2__7_0_-_6__8_3_-_3_0__5_7______ O/O Mailing Address: __________3_8_3__0__V_i_n_c_e_n__t_S_t_a_t_i_o_n__D_r_i_v_e________________________________________________ City: _____O__w_e__n_s_b_o__ro________________ County: ______H_a_n__c_o_c_k__________________ State:___K_Y____ Zip: __4_2_3__0_3__ Well Data from File Well Name & #: ____M__a_r_y_M__a__d_d_e_n__-R__ic_h__a_r_d_s__#_W__-_1________________________________________________________ Well Type (see table): ______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_._7_0_7__9_2__5_________ Longitude (W): _____-_8_6__._7_1_9__1_8__3_______ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; XTubing & Packer; Cemented Injection Tubing Other: __s__u_r_fa__c_e__c_a_s_i_n_g__7_"_______________________________________________ Total Depth (ft): __________ Inner Casing Size (in): ____5_"___ Tubing Size (in):____1_"_____ Packer Depth (ft): ________ Inj. Zone: Open Hole; Perforated; Top(ft) ________ Bottom(ft): ___________ Max. Injection Pressure (psig): __2_6_0____ Field Measurements and Observations Latitude (N): ______3__7_._7_0_7__9_1___________ Longitude (W): ______-_8_6__.7__1_9_1__8________ Elevation (ft): ____________ EPA GPS ID: _S_7__5_3_3__2_ Well Status (see table): ___A__B____ If not Active, Reported Date Last Active: ___2__/_1_3__/_2_0__1_3____ Nature of Injected Fluid(s) if any: __________________________________________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): __T_h__e_M__a_r_y__M__a_d_d__e_n_-_R_i_c_h_a__rd__s_l_e_a_s__e_i_s_l_o_c_a__te__d__in_______ __R_e_y_n__o_l_d_s__S_t_a_t_io_n__,_K_e__n_t_u_c_k_y_,__4_2_3__6_8__. _______________________________________________________________ _W__e_l_ls__#_W__-_2__a_n_d__W__-_3__a_r_e__n_o_t_a__u_t_h_o_r_i_z_e_d__b_y__P_e_r_m__it__N_o_.__K_Y_A__0_3_6__2_._O__n_l_y_W__-_1_,_W__-_4_,__W__-5__, _W__-6__a__n_d__W__-7__. __ The injection well is disconnected from the flow line. The casing has a lot of corrosion, with _____________________________________________________________________________________________________ _m__e_t_a_l_li_c__p_ie__c_e_s__b_r_e_a_k_i_n_g__a_p__a_r_t _a_n_d__s_e__p_a_r_a_t_i_n_g__fr_o_m___o_n_e__a__n_o_t_h_e_r_,_a__s_s_e__e_n__in__t_h_e__p_h__o_t_o_s_._____________ _M__u__c_h__o_f_t_h_e__w__e_ll__a_n_d__f_lo__w__li_n_e_s__a_r_e__b_o_u__n_d__w_i_t_h__s_il_v_e_r__ta_p__e_,_w__h_i_c_h__is__c_o_m__i_n_g__u_n_w__r_a_p_p_e__d__a_s__y_e_a_r_s_____ _h_a__v_e__g_o_n_e__b__y_. _T_h_e__i_n_je__c_t_io_n__t_u_b__in__g_i_s__P_o_l_y_v_in__y_l _C_h__lo_r_i_d_e__(_P_V_C__)._______________________________________ See reverse for additional observations, comments and photo log UIC Inspector UIC Inspector Name:_______C_a__ro__l _C_h__e_n______________________________ Name:______________________________________________ CAROL CHEN Date: 2024.03.27 16:40:13 -04'00' Digitally signed by CAROL CHEN Signature: ___________________________________________ Signature: ___________________________________________ 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 0 9 1 0 1 1 9 Year-Month-Day: 2 0 2 4 - 0 2 - 2 1 EPA Permit # (or RA): K Y A 0 Page 2 36 2 Of 2 (Cont) _____M__a_r_y__M__a_d_d_e__n_-_R_i_c_h_a_r_d_s__#__W_-_1_______________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Photo Log Photographer:_________B_r_i_a_n_n_a__L_a_P_a_p__a____________ EPA Camera ID: ________S_7__5_3_3__2_______________________ Photo ID: ___R_I_M__G_0_0__6_0_____Time: __1_:_5_6__p_m____ Lat (N): ___3_7__.7_0__6_8_4__3________ Long (W) ___-8__6_.7__1_6_5__2_3_________ Description: ta__n_k__b_a_t_t_e_r_i_e_s_w__i_th__r_e_d__D__a_n_g__e_r_s_i_g_n_,__la_b__e_l_e_d__fo__r_f_la__m__m__a_b_l_e_v__a_p_o_r_,_p__e_t_ro__le__u_m__c__ru__d_e__o_i_l _____ Photo ID: ___R__IM__G__0_0_6_1_____Time: __1__:5_6__p_m____ Lat (N): ___3_7__.7_0__7_8_6__8________ Long (W) ____-8__6_.7__1_9_4__2_3________ Description: v_i_e_w__o__f _t_h_e__ta__n_k__b_a_t_t_e_r_y__o_n__o_p_p__o_s_it_e__s_i_d_e_,__4__t_a_n_k__s_i_n__t_o_t_a_l,__D_O__W__#_0_9__1_0__0_5__2________________ Photo ID: ____R_I_M_G__0_0_6__2____Time: __1__:5_6__p_m____ Lat (N): ___3_7__.7_0__7_8_6__8________ Long (W) ___-_8_6_._7_1_9__3_7_5_________ Description:_p_h__o_t_o__s_h_o_w__in__g_t_h__e_b__a_c_k__o_f_t_h_e__t_a_n__k_b__a_t_t_e_r_y_______________________________________________ Photo ID: ___R__IM__G__0_0_6_3_____ Time: __1_:_5_7__p_m____ Lat (N): ____3_7_._7_0_7__9_1_8________ Long (W) ____-_8_6_._7_1_9__1_6_5________ Description:__in__je_c__ti_o_n__w__e_ll__is__d_i_s_c_o_n__n_e_c_t_e_d__f_r_o_m__t_h__e_f_l_o_w__l_in__e__________________________________________ Photo ID: ___R__IM__G__0_0_6_4_____ Time: ___1_:_5_7__p_m___ Lat (N): ____3_7_._7_0_7__9_1_________ Long (W) ____-8__6_.7__1_9_1__8_________ Description:__c_lo_s__e_-u__p__p_h_o_t_o__o_f__in__je_c_t_i_o_n__w__e_ll_,_c_o_r_r_o_s_i_o_n__o_f__th__e__c_a_s_i_n_g___________________________________ Photo ID: ____R_I_M_G__0_0_6__5____ Time: ___1_:5__7__p_m___ Lat (N): ____3_7_._7_0__7_9_2_8________ Long (W) ____-8_6__.7__1_9_1__8_3________ Description: __a_n_o__th__e_r_p__h_o_t_o__o_f_t_h_e__i_n_j_e_c_t_io__n_w__e_l_l,__th__is__t_im__e__f_a_r_t_h_e_r__b_a_c_k_________________________________ UIC Inspector UIC Inspector Name:_______C_a__ro__l _C_h__e_n____________________________ Name: ______________________________________________ Signature: _C__A__R__O___L___C__H__E__N___D_a_t_e:_2_0_24_.0_3_.2_7_1_6_:4_0_:4_0_-0_4_'0_0_' Signature: ___________________________________________ Digitally signed by CAROL CHEN Version 2018-04-18