FIR 1 - INSPECTION REPORT

Permit Holder: P & H Vacuum Service Well Name/No: Genoa Central School Permit: 30458
Lease Name: Genoa Central School 1 Sec: 10 Twp: 16S Range 27W
GPS Well Location: Latitude: 33.37128 Longitude: -93.88058 Field: GENOA  
Lease/Tank Battery: Latitude: 0 Longitude: 0 County: MILLER  
Entrance from nearest 911 address, public street or highway
Status:
Well equipment operational: Equipment plumbed properly: Excess equipment on lease:
Signs: At lease entrance:
At tank battery:
At well:
Signage compliance:

NoTypeConstructionSizeLeaksRemarks
No Vessels Found For This Inspection

Tank Containment:
Dimensions: Length: 0 Width: 0 Diameter: 0 Height: 0 Capacity (bbls): 0
Capacity compliance: Breaches/Erosion: Excessive vegetation present: Compliance agreement:
Containment Conditions: Fluids Present:
Well Site Compressor:
Is it in compliance?
Trash/Debris:
Use as storage area:
Unusual equipment:
Excessive erosion:
If yes to any, explain:
Entry Gate Present:
  Gate locked on arrival:
Gate locked on departure:
Is spill or discharge of drilling, completion or produced fluids present:
 
If yes, did spill or discharge of drilling, completion or produced fluids occur or travel off the well pad:
(If yes, complete FIR 5)
Compliance Summary Remarks:
Well presents with casing and tubing. Flow line is not connected. There is no concrete slab or pumping unit on site. Casing and tubing are secured with valves and bull plugs. Well is inactive and shut in.

Inspected by: RONNIE KENNEDY   Date:  11/14/2016 9:07:00 AM
Review for NNC or NOV:
If yes, check one
Ref #: Date: __________
ADEQ referral:
Date of referral:  __________