Document zzy579Dwe1odqbXxO3pvnOOZR

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 EPA Well ID#: F L S 1 1 3 0 0 2 8 Year-Month-Day: 2 0 2 4 - 0 5 - 0 1 EPA Permit # (or RA): Page 1 Of 2 Inspector(s): ______C_a_r_o_l_C__h_e_n___________________ (lead), _______C_a_r_la__F_o_y_____________________ Start Time: _1_1_:_1_5__a__m_ ____________________________________ , _______________________________________ End Time: _1_1_:_2_1__a__m_ Facility Contact Information Facility Name:__M__a_v_e_r_i_c_k__N_a_t_u_r_a__l _R_e_s__o_u_r_c_e_s_,__L_L_C________________________________________________________ Street Address:_5__4_1__5__O_i_l _P_l_a_n_t__R_d_______________________________________________________________________ City: _____J_a_y________________________ County: ___S__a_n_t_a__R_o__s_a_________________ State:___F_L____ Zip: _3__2_5__6_5__ Nature of Business: _____o_i_l _a_n_d__g_a__s_p__ro__d_u_c_t_i_o_n___________________________________________________________ Facility Owner/Operator: _M__a_v_e__r_ic_k__N__a_t_u_r_a_l_R__e_s_o_u__rc_e__s_,_L_L_C________________ Phone: _8__5_0__-6__7_5_-_1_7__0_2_________ Email: ________________________________________________________________________________________________ Facility Contact (if different): __A_l__J_o_n_e_s_,__P_l_a_n_t__S_u_p_e__r_in_t_e_n__d_e_n__t _______________ Phone: __2_5_1__-2__2_7__-3__3_1_9_________ O/O Mailing Address: ___5_4__1_5__O__il_P__la__n_t_R__d________________________________________________________________ City: ______J_a_y_______________________ County: ____S__a_n_t_a__R_o__s_a________________ State:__F_L_____ Zip: __3_2__5_6_5__ Well Name & #: ______F_r_a_n_k__N__o_w__li_n_g__#_2__4_-_4__________________A_P_I_N__o_.__0__9_-_1_1_3__-2__0_1__2_7______P__A__N_o__. _3_1__1_6_0__0_ Well Type (see table): __E_n__h_a_n_c__e_d__O_i_l_R_e__c_o_v_e_r_y__(E__O_R__)_______________ State Permit: ______O_G____6_8__8_____________ Latitude (N): ______3_0__.9__2_9__0_6__5_________ Longitude (W): ___-_8_7_._1_2__8_7__0_2__________ Elevation (ft): ____________ Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing PBTD: 15894' Other: ____s_u_r_f_a_c_e__c_a__s_in__g_9__5__/_8_"__a_t_3__8_6_1__'_______________________________ 9 sets of perforations 15940' 7" at 15940' 3 1/2" at15500' Total Depth (ft): __________ Inner Casing Size (in): ________ Tubing Size (in):__________ Packer Depth (ft): 1__5_4_8__0_'_ Inj. Zone: Open Hole; X Perforated; Top(ft) 1__5_6__7_4_'_ Bottom(ft): __1_5__8_3__9_'__ 7500 N2 gas 4400psi PW Max. Injection Pressure (psig): ________ Well Data from File Field Measurements and Observations Latitude (N): ____N__o__G_P_S__0__0_0___________ Longitude (W): ____N_o__G__P_S__0__0_0_________ Elevation (ft): ____________ EPA GPS ID: __S_C_8__2_8__4 Well Status (see table): ___A__C____ If not Active, Reported Date Last Active: __________________ Nature of Injected Fluid(s) if any: __________________________________________________________________________ General Condition of the Well Site: _________________________________________________________________________ _____________________________________________________________________________________________________ Notes & Comments (include discrepancies from database values): ______________________________________________________ _D_A_N__G__E_R__s_i_g_n_:_H__S__M__a_y__b_e__P__re__s_e_n_t_._.._H_a_z__a_r_d_o_u_s__O__p_e_r_a_t_io__n_s_._.._K_e__e_p__O_u_t_._.______________________________ ___"__T_-s_k__il_le_t__w_a__s_i_n_s_e__rt_e_d__o_n__t_h_e__N__it_r_o_g_e_n__(_N___) _g_a_s__l_in_e_______T_u_b__in_g__G_a__u_g_e_:_________1__4_0__0__p_s_i__________ _t_o__s_t_o_p__g_a_s__in__je__c_ti_o_n__. ______________________________________P__ro_d__u_c_ti_o_n__G_a_u__g_e_:_____0__p__s_i ______________ ____________________________________________________________S__u_rf_a_c_e__G_a__u_g_e_:________0__p__s_i ______________ ____________________________________________________________F_l_o_w__L_i_n_e_G__a_u_g_e__: _________________________ _____________________________________________________________________________________________________ See reverse for additional observations, comments and photo log UIC Inspector UIC Inspector Carol Chen Name:_______________________________________________ Name: ______________________________________________ Signature: _C_A__R__O__L__C__H_E__N_______D_a_te_: _20_2_4._06_.2_0_2_1:_48_:1_6_-0_4_'0_0'___ 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#: F L S 1 1 3 0 0 2 8 Year-Month-Day: 2 0 2 4 - 0 5 - 0 1 EPA Permit # (or RA): Page 2 Of 2 (Cont) ________________________________________________________________________________________________ _________F_r_a_n__k_N__o_w__li_n_g__#__2_4_-_4_____________O__G____6_8_8_____________________A_P_I__N_o_._0__9_-_1_1__3_-_2_0__1_2_7__________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Photo Log Photographer: ________C_a_r_l_a_F__o_y_______________ EPA Camera ID:_____________S_C__8_2__8_4_________________________ Photo ID: ___D_S__C_N__1_4_0__9____Time: _1__1_:_1_7__a_m___ Lat (N): __N__o__G_P__S__0_0__0_______ Long (W) ___N_o__G__P_S__0__0_0________ Description: __in__je_c__ti_o_n__w__e_ll__id__e_n_t_if_i_c_a_t_io__n_s__ig_n__a__t _p_r_o_p_e__r_ty__e_n_t_r_a_n__c_e_____________________________________ Photo ID: ___D_S_C__N_1__4_1__0____Time: _1__1_:_1_8__a_m___ Lat (N): ___N__o__G_P_S__0__0_0_______ Long (W) ___N_o__G__P_S__0_0__0________ injection well, identification sign, DANGER sign: H S May be Present...Keep Out... Description: ___________________________________________________________________________________________ Photo ID: __D__S_C__N_1__4_1_1_____Time: _1_1__:2__0__a_m___ Lat (N): ___N__o_G__P_S__0__0_0_______ Long (W) __N__o__G_P__S__0_0__0________ Description: _p_h__o_t_o_o__f___"__T_-s__k_il_le__t_w__a_s__in__s_e_r_te__d__o_n__t_h_e__N_i_t_ro__g_e_n__(_N__)__g_a_s__li_n_e____________________________ Photo ID: __D__S_C__N_1__4_1__2____Time: _1_1_:_2_0__a_m____ Lat (N): ___N_o__G__P_S__0_0__0_______ Long (W) __N__o_G__P_S__0__0_0_________ injection tubing gauge reads 1400 psi Description: ___________________________________________________________________________________________ Photo ID: __D__S_C__N_1__4_1__3____Time: _1__1_:_2_1__a_m___ Lat (N): __N__o__G_P__S__0_0_0________ Long (W) __N__o__G_P_S__0__0_0_________ Description: _p__ro__d_u_c_t_i_o_n__g_a_u__g_e__re__a_d_s__0__p_s_i_,_s_u__rf_a_c__e_g__a_u_g_e__r_e_a_d__s_0___p_s_i_________________________________ Photo ID: _________________Time: ____________ Lat (N): _____________________ Long (W) ______________________ Description: ___________________________________________________________________________________________ UIC Inspector UIC Inspector Name:_______C_a_r_o_l_C__h_e_n_______________________________ Name: ______________________________________________ Signature: _C_A__R_O__L__C__H_E__N________D_a_te_: 2_0_24_.0_6._20_2_1_:48_:4_3_-0_4_'00_' ____ Signature: ___________________________________________ Digitally signed by CAROL CHEN Version 2018-04-18