Document zo17MGeeDomd4QZ2NZJnBY8b3

Well ID: 136760 Legal Location North X --------- One M ile---------- Each square is 10-acres 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: 136760 Quarters NE-SW-SE Latitude 36.667843 Section 04 Township 25N Longitude -96.3377231 Range 09EI Date collected(latitude and longitude), if different from date the well was drilled: 07/01/2011 Method latitude and longitude was collected: GPS - uncorrected data County7 Osage WELL OWNER - NAME AND ADDRESS Well Owner Pawhuska Upper Elementary7 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 07/01/2011 Number of wells or borings represented by this log 63 * (Borings are within the same 10 acre-tract and with the same general depths and lithologies) Hole Diameter 4.25 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 t o ___ft SCREEN OR PERFORATION INFORMATION Sierra Club v. EPA 18cv3472 NDCA Tiers 8&9 http://www.owrb.ok.gov/wd/reporting/printreport.php?siteid=136760[8/22/2017 10:06:31 AM] ED 002061 00172017-00001 Well ID: 136760 FILTER PACK INFORMATION Filter Pack Material: __ WELL SEAL INFORMATION Type of Surface Seal n/a Type o f 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 LITHOLOGY DESCRIPTION Surface Seal Interval: From n/a ft to n/a ft Annular Seal Interval: From 15 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 |Yellow Shale iLimestone jRed. San. Grave jGray Shale Blue Shale jRed. San. Grave Blue Shale 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 < 5 0 feet, from possible source. Type of possible source: House PLUGGING INFORMATION Date Well or Boring Was Plugged 07/01/2011 Total Depth o f 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 Bentonite Backfilled from 15 ft. to 250 ft. Grouted with H. S. Bentonite Grout Grouted from 15 ft. to 250 ft. Grouted with Cement Grouted from _5_ ft. to 15 ft. Firm Name ZAVALA DRILLING Operator Name RAUL ZAVALA Date 07/01/2011 Comments: These are geothermal heat exchange wells D/PC No. DPC-0747 OP No. OP-1673 Sierra Club v. EPA 18cv3472 NDCA Tiers 8&9 http://www.owrb.ok.gov/wd/reporting/prmtreport.php?siteid=136760[8/22/2017 10:06:31 AM] ED 002061 00172017-00002