Document qam90gNjONrXVZ2OazKJRakmx

Well ID: 156457 Legal Location MULTI-PURPOSE WELL COMPLETION & PLUGGING REPORT Oklahoma Water Resources Board 3800 North Classen Boulevard Oklahoma City, OK 73118 Telephone (405) 530-8800 WELL ID NUMBER: 156457 Quarters SW-NW-SE Latitude 36.66998 Section 04 Township 25N Longitude -96.340429 Range 09EI Date collected(latitude and longitude), if different from date the well was drilled: 11/11/2013 Method latitude and longitude was collected: Derived from GIS ---------One M ile---------- Each square is 10-acres County Osage WELL OWNER - NAME AND ADDRESS Well Owner Osage Nation Address/City/State Pawhuska OK Finding Location ___ Well Name ___ TYPE OF WORK: Geothermal or Heat Pump Well Variance Request No. (if applicable) n/a Phone _______ Zip ____ Water Rights #: ___ USE OF WELL: Heat Exchange NEW WELL CONSTRUCTION DATA Date Well or Boring Was Completed 11/11/2013 Number of wells or borings represented by this log 1 * (Borings are within the same 10 acre-tract and with the same general depths and lithologies) Hole Diameter 4.75 inches to a depth of 250 ft. CASING INFORMATION "Note: If surface casing is used please indicate that on the appropriate well casing information line. Surface Pipe Material: __ Surface Pipe Diameter __ inches Surface Pipe From __ ft to ___ft SCREEN OR PERFORATION INFORMATION Sierra Club v. EPA 18cv3472 NDCA Tiers 8&9 http://www.owrb.ok.gov/wd/reporting/printreport.php?siteid=l 56457(8/22/2017 10:05:50 AM] ED 002061 00172013-00001 Well ID: 156457 FILTER PACK INFORMATION Filter Pack Material: __ WELL SEAL INFORMATION Type of Surface Seal n/a Type of Annular Seal H. S. Bentonite Grout Filter Pack Seal Material n/a TYPE OF COMPLETION: Below Ground HYDROLOGIC INFORMATION Depth to water at time of drilling ft Surface Seal Interval: From n/a ft to n/a ft Annular Seal Interval: From 0 ft to 250 ft Filter Pack Seal Interval: From n/a ft to n/a ft Estimated yield of well gpm First water zone ft LITHOLOGY DESCRIPTION i jYellow Clay jBlue Shale jLimestone jRed Stone jLimestone jRed Stone jBrown Rock jGray Rock jBrown Rock jLimestone jGray Rock MATERIAL WELL LOCATION TO POTENTIAL SOURCES OF POLLUTION Has this well been disinfected after completion of work? No Are than any potential sources of pollution or wastewater lagoons within 300 ft. of the well? Y Distance of Well is 101 - 300 feet from possible source. Type of possible source: House PLUGGING INFORMATION Date Well or Boring Was Plugged 11/11/2013 Total Depth of well being plugged 250 ft. Was the well contaminated or was it plugged as though it was contaminated? No If the well or boring was plugged as if it was contaminated, was the casing removed or perforated? No Was the grout tremied? Yes Backfilled with n/a Backfilled from ft. to ft. Grouted with H. S. Bentonite Grout. Grouted from _0_ ft. to 250 ft. Grouted with Cement Grouted from ___ft. to ft. Firm Name ZAVALA DRILLING Operator Name RAUL ZAVALA JR Date 12/20/2013 Comments: These are heat exchange wells. D/PC No. DPC-0747 OP No. OP-1805 Sierra Club v. EPA 18cv3472 NDCA Tiers 8&9 http://www.owrb.ok.gov/wd/reporting/printreport.php?siteid=156457[8/22/2017 10:05:50 AM] ED 002061 00172013-00002 Well ID: 156457 Sierra Club v. EPA 18cv3472 NDCA Tiers 8&9 http://www.owrb.ok.gov/wd/reporting/prmtreport.php7siteidM56457t8/22/2017 10:05:50 AM] ED 002061 00172013-00003