Well ID: 9019

MULTI-PURPOSE WELL COMPLETION & PLUGGING REPORT

Oklahoma Water Resources Board
3800 North Classen Boulevard
Oklahoma City, OK 73118
Telephone (405) 530-8800

Legal Location
North

		x

«——— One Mile ———»
Each square is 10-acres

WELL ID NUMBER: 9019
Quarters NW-NE-NE	Section 23	Township 01N	Range 23EC

Latitude 36.542817	Longitude -100.543953
Date collected(latitude and longitude), if different from date the well was drilled: 10/20/1998
Method latitude and longitude was collected: Interpolation from PLSS

County Beaver

Variance Request No. (if applicable) n/a

WELL OWNER - NAME AND ADDRESS

Well Owner NO NAME AVAILABLE

Phone

Address/City/State OK

Zip

Finding Location

Well Name

Water Rights #:

TYPE OF WORK: Groundwater Well

USE OF WELL: Domestic

NEW WELL CONSTRUCTION DATA

Date Well or Boring Was Completed 01/01/1907

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)

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

FILTER PACK INFORMATION

Filter Pack Material:

WELL SEAL INFORMATION

Type of Surface Seal n/a

Surface Seal Interval: From n/a ft to n/a ft

Type of Annular Seal n/a

Annular Seal Interval: From n/a ft to n/a ft

Filter Pack Seal Material n/a

Filter Pack Seal Interval: From n/a ft to n/a ft

TYPE OF COMPLETION:

HYDROLOGIC INFORMATION

Depth to water at time of drilling ft

Estimated yield of well gpm

First water zone 169 ft

LITHOLOGY DESCRIPTION

MATERIAL	ENCOUNTERED		SATURATED
MATERIAL	FROM (ft.)	TO (ft.)	SATURATED
none	0	1	N

WELL LOCATION TO POTENTIAL SOURCES OF POLLUTION

Has this well been disinfected after completion of work? n/a

Are than any potential sources of pollution or wastewater lagoons within 300 ft. of the well? n/a

Distance of Well is n/a from possible source. Type of possible source: n/a

PLUGGING INFORMATION

Date Well or Boring Was Plugged n/a

Total Depth of well being plugged ft.

Was the well contaminated or was it plugged as though it was contaminated? n/a

If the well or boring was plugged as if it was contaminated, was the casing removed or perforated? n/a

Was the grout tremied? n/a

Backfilled with n/a

Backfilled from _ ft. to _ ft.

Grouted with n/a

Grouted from ft. to ft.

Grouted with Cement

Grouted from ft. to ft.

Firm Name n/a	D/PC No.
Operator Name	OP No.
Date 01/01/1907
Comments: n/a