Document zo88ZO3KGDDmVXm1k6MbwNBog

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 Year-Month-Day: 2 0 2 4 EPA Permit # (or RA): K 99 00 05 - 02 -2 1 Y I 0 590 Phone: (404)562-9424 Page 1 Of 2 Inspector(s): _____C__a_r_o_l_C__h_e_n__________________ (lead),______B_r_i_a_n_n__a__L_a_P_a__p_a_____________ Start Time:1_0__:0__4__a_m__ ____________________________________, ____________________________________ End Time:1__0_:_0_8__a_m__ Facility Contact Information Logsdon Valley Oil Co., Inc. Facility Name: __________________________________________________________________________________________ Street Address:______1__0_5__B__e_d_f_o_r_d__C_o__u_r_t________________________________________________________________ City: ____H_o_r_s_e__C__a_v_e_________________ County: __________H__a_r_t_________________ State:___K__Y___ Zip: _4__2_7__4_9__ Nature of Business: _______O_i_l_a_n__d__g_a_s__e_x_t_r_a_c_t_io__n_________________________________________________________ Facility Owner/Operator: ________L__o_g_s_d__o_n__V_a_l_le__y_O__il_C__o_._,_I_n_c_.______________ Phone: ____2__7_0_-_5_3__7_-_4_2__8_8______ Email: _______e_s__ti_n_s_o__n_@__s_c_r_tc__.c_o__m______________________________________________________________________ Facility Contact (if different): _____E_l_le_n__S__ti_n_s_o__n_,_P_r_e__s_id_e__n_t____________________ Phone: ____2_7__0_-_5_3__7_-_4_2__8_8______ O/O Mailing Address: ________1_0__5__B_e_d__fo__rd__C__o_u_r_t__________________________________________________________ City: ______H__o_r_s_e__C_a_v_e_______________ County: __________H__a_r_t_________________ State:____K_Y___ Zip: __4_2__7_4__9_ Well Data from File Well Name & #: ___________C_a__r_te__r__&__C__h_a__n_e__y__#_V__A_-_2____________________________________________________ Well Type (see table): _____E_n__h_a_n__c_e_d__O_i_l_R__e_c_o_v_e__ry__(_E_O__R_)____________ State Permit: ________3__6_4_7__1____________ Latitude (N): ______3_7__.1__8_3_3__9___________ Longitude (W): ______-8__5_._7_8__5_2_6_________ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; XTubing & Packer; Cemented Injection Tubing PBTD: Other: __________________________________________________________________ 625' 4" to 625' 2" Total Depth (ft): __________ Inner Casing Size (in): ________ Tubing Size (in):__________ Packer Depth (ft): ________ Inj. Zone: Open Hole; Perforated; Top(ft) ________ Bottom(ft): ___________ Max. Injection Pressure (psig): ________ Latitude (N): ______3_7_._1_8__3_4__7_3_________ Longitude (W): ____-8___5____.__7____8____5___2____2____7_________________ Elevation (ft): ____________ EPA GPS ID: S__7_5_3__3_2__ Well Status (see table): ____P_A____ If not Active, Reported Date Last Active: __________________ Field Measurements and Observations Nature of Injected Fluid(s) if any: __________________________________________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): ______________________________________________________ __W__e_ll__is__p_l_u_g_g_e__d_,_b_u__t_4____"_c_a_s_i_n_g__a_t_s__u_r_fa__c_e__w_a_s__n_o__t_r_e_m__o_v_e__d_._______________________________________ __I_n_j_e_c_t_i_o_n__w_e__ll_i_s__v_ie__w_e_d__w__it_h_i_n__a__la__rg__e_c__e_m__e_n_t__p_a_d__, _s_e_v_e_r_a__l _fe__e_t_i_n__d_i_a_m__e_t_e_r_._______________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ See reverse for additional observations, comments and photo log UIC Inspector UIC Inspector Name:_______C_a__r_o_l__C_h__e_n_____________________________ Name: ______________________________________________ CAROL CHEN Date: 2024.03.27 18:52:48 -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 EPA Well ID#: K Y S 0 9 9 0 0 0 5 Year-Month-Day: 2 0 2 4 - 0 2 - 2 1 EPA Permit # (or RA): K Y I 0 5 9 0 Phone: (404)562-9424 Page 2 Of 2 (Cont) __U_I_C__C_l_a_s_s__I_I____C__a_r_t_e_r_&__C__h_a_n__e_y__#_V_A__-2______P_l_u_g_g_e__d__a_n_d__A_b__a_n_d__o_n_e_d____________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 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_3__1____Time: __1_0__:0__7__a_m__ Lat (N): ____3_7__.1__8_3_9__6_7_______ Long (W) ___-_8_5__.7__8_3__1_7_2_______ Description: _i_n_j_e_c_t_i_o_n__w_e__ll_c_a__s_in__g_,_w__it_h_i_n__c_e_m__e_n__t_p_a_d___________________________________________________ Photo ID: ___R_I_M__G_0__0_3__2____Time: __1__0_:_0_7__a_m__ Lat (N): ____3__7_._1_8_3__4_7__3______ Long (W) ___-_8_5__.7__8_5__2_2_7_______ Description: __c_l_o_s_e_r__lo_o__k_o__f_i_n_je__c_t_io_n__w__e_l_l _c_a_s_i_n_g_,__c_o_v_e_r_e_d__i_n__c_e_m__e_n__t___________________________________ Photo ID: ___R_I_M__G_0__0_3__3____Time: __1__0_:_0_8__a_m__ Lat (N): ____3__7_._1_8_3__4_0__7______ Long (W) ____-_8_5__.7__8_5_1__7_7______ Description: _i_n_j_e_c_t_i_o_n__w_e__ll_c_a__s_in__g_,_w__it_h_i_n__c_e_m__e_n__t_p_a_d___________________________________________________ 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 Carol Chen Name:_______________________________________________ CAROL CHEN Digitally signed by CAROL CHEN Date: 2024.03.27 18:53:20 -04'00' Signature: ___________________________________________ UIC Inspector Name: ______________________________________________ Signature: ___________________________________________ Version 2018-04-18