FIR 1 - INSPECTION REPORT

Permit Holder:	Jackson Family Oil Company LLC			Well Name/No:	Jackson	Permit:	28169
Lease Name:	Jackson 1	Sec:	18	Twp:	14S	Range	23W
GPS Well Location:		Latitude:	33.5326	Longitude:	-93.5176	Field:	PATMOS NORTH
Lease/Tank Battery:		Latitude:	0	Longitude:	0	County:	HEMPSTEAD
Entrance from nearest 911 address, public street or highway

Status:

Completing New not producing Operating Old not producing Not found

Single well pad Mutiple well pad NA

Well equipment operational:	Equipment plumbed properly:	Excess equipment on lease:
Yes No NA	Yes No NA	Yes No

Signs:

At lease entrance:

Yes No

At tank battery:

Yes No NA

At well:

Yes No NA

Signage compliance:

Yes No

Tank Containment:

Earthen Metal ring Tank in tank No Tanks Other

Dimensions:

Length:

0

Width:

0

Diameter:

0

Height:

0

Capacity (bbls):

0

Capacity compliance:		Breaches/Erosion:		Excessive vegetation present:			Compliance agreement:
Yes No NA		Yes No NA		Yes No NA			Yes No NA

Containment Conditions:

Fluids Present:

Yes No

Produced fluids Storm water Waste oil NA Other

Well Site Compressor:

Yes No

Is it in compliance?

Yes No NA

Trash/Debris:	Yes No	Use as storage area:	Yes No	Unusual equipment:	Yes No	Excessive erosion:	Yes No
If yes to any, explain:

Entry Gate Present:

Yes No

Gate locked on arrival:

Yes No

Gate locked on departure:

Yes No

Is spill or discharge of drilling, completion or produced fluids present:					Yes No
If yes, did spill or discharge of drilling, completion or produced fluids occur or travel off the well pad:								Yes No NA	(If yes, complete FIR 5)
Compliance Summary Remarks:
Well is present with casing, tubing and rods. There is no concrete slab or pumping unit. Casing and tubing are secured with valves and bull plugs. Rods are secured with a clamp bolt. Well is inactive and shut in.

Inspected by:	RONNIE KENNEDY				Date:  1/12/2022 2:23:00 PM
Review for NNC or NOV:	Yes No	If yes, check one	NNC NOV DNI NA	Ref #:	Date: __________
ADEQ referral:	Yes No	Date of referral:  __________