+-----------------------------+---+---+-----+-----------------------------+
| ## Borehole /               |   |   |     |                             |
| Well Completion Information |   |   |     |                             |
|                             |   |   |     |                             |
| Date/Time: Sheet of         |   |   |     |                             |
|                             |   |   |     |                             |
| Technical Area Focus Area   |   |   |     |                             |
| Site Work Plan:             |   |   |     |                             |
|                             |   |   |     |                             |
| Field Team Leader:          |   |   |     |                             |
|                             |   |   |     |                             |
| (Print name and title, then |   |   |     |                             |
| sign)                       |   |   |     |                             |
|                             |   |   |     |                             |
| Installer:                  |   |   |     |                             |
|                             |   |   |     |                             |
| (Print name and title, then |   |   |     |                             |
| sign)                       |   |   |     |                             |
+-----------------------------+---+---+-----+-----------------------------+
| Borehole / Well             |   |   |     |                             |
| Construction Information    |   |   |     |                             |
+-----------------------------+---+---+-----+-----------------------------+
| Borehole ID:                |   | S |     |                             |
|                             |   | u |     |                             |
| Drilling Method:            |   | r |     |                             |
|                             |   | f |     |                             |
| Drilling Fluids Used:       |   | a |     |                             |
|                             |   | c |     |                             |
| Estimated Amounts:          |   | e |     |                             |
|                             |   | S |     |                             |
| Casing Material(s):         |   | e |     |                             |
|                             |   | a |     |                             |
|                             |   | l |     |                             |
|                             |   | M |     |                             |
|                             |   | a |     |                             |
|                             |   | t |     |                             |
|                             |   | e |     |                             |
|                             |   | r |     |                             |
|                             |   | i |     |                             |
|                             |   | a |     |                             |
|                             |   | l |     |                             |
|                             |   | : |     |                             |
|                             |   |   |     |                             |
|                             |   | A |     |                             |
|                             |   | n |     |                             |
|                             |   | n |     |                             |
|                             |   | u |     |                             |
|                             |   | l |     |                             |
|                             |   | a |     |                             |
|                             |   | r |     |                             |
|                             |   | S |     |                             |
|                             |   | e |     |                             |
|                             |   | a |     |                             |
|                             |   | l |     |                             |
|                             |   | M |     |                             |
|                             |   | a |     |                             |
|                             |   | t |     |                             |
|                             |   | e |     |                             |
|                             |   | r |     |                             |
|                             |   | i |     |                             |
|                             |   | a |     |                             |
|                             |   | l |     |                             |
|                             |   | : |     |                             |
+-----------------------------+---+---+-----+-----------------------------+
|                             |   | F |     |                             |
|                             |   | i |     |                             |
|                             |   | l |     |                             |
|                             |   | t |     |                             |
|                             |   | e |     |                             |
|                             |   | r |     |                             |
|                             |   | P |     |                             |
|                             |   | a |     |                             |
|                             |   | c |     |                             |
|                             |   | k |     |                             |
|                             |   | M |     |                             |
|                             |   | e |     |                             |
|                             |   | s |     |                             |
|                             |   | h |     |                             |
|                             |   | S |     |                             |
|                             |   | i |     |                             |
|                             |   | z |     |                             |
|                             |   | e |     |                             |
|                             |   | : |     |                             |
|                             |   |   |     |                             |
|                             |   | F |     |                             |
|                             |   | i |     |                             |
|                             |   | l |     |                             |
|                             |   | t |     |                             |
|                             |   | e |     |                             |
|                             |   | r |     |                             |
|                             |   | P |     |                             |
|                             |   | a |     |                             |
|                             |   | c |     |                             |
|                             |   | k |     |                             |
|                             |   | M |     |                             |
|                             |   | a |     |                             |
|                             |   | t |     |                             |
|                             |   | e |     |                             |
|                             |   | r |     |                             |
|                             |   | i |     |                             |
|                             |   | a |     |                             |
|                             |   | l |     |                             |
|                             |   | : |     |                             |
+-----------------------------+---+---+-----+-----------------------------+
|                             |   | S |     |                             |
|                             |   | c |     |                             |
|                             |   | r |     |                             |
|                             |   | e |     |                             |
|                             |   | e |     |                             |
|                             |   | n |     |                             |
|                             |   | M |     |                             |
|                             |   | a |     |                             |
|                             |   | t |     |                             |
|                             |   | e |     |                             |
|                             |   | r |     |                             |
|                             |   | i |     |                             |
|                             |   | a |     |                             |
|                             |   | l |     |                             |
|                             |   | : |     |                             |
|                             |   |   |     |                             |
|                             |   | S |     |                             |
|                             |   | c |     |                             |
|                             |   | r |     |                             |
|                             |   | e |     |                             |
|                             |   | e |     |                             |
|                             |   | n |     |                             |
|                             |   | S |     |                             |
|                             |   | l |     |                             |
|                             |   | o |     |                             |
|                             |   | t |     |                             |
|                             |   | S |     |                             |
|                             |   | i |     |                             |
|                             |   | z |     |                             |
|                             |   | e |     |                             |
|                             |   | : |     |                             |
+-----------------------------+---+---+-----+-----------------------------+
| Well Type                   | S |   |     |                             |
|                             | o |   |     |                             |
| Monitoring                  | u |   |     |                             |
|                             | r |   |     |                             |
| Treatment                   | c |   |     |                             |
|                             | e |   |     |                             |
| Other (describe)            |   |   |     |                             |
|                             | R |   |     |                             |
|                             | e |   |     |                             |
|                             | g |   |     |                             |
|                             | i |   |     |                             |
|                             | o |   |     |                             |
|                             | n |   |     |                             |
|                             | a |   |     |                             |
|                             | l |   |     |                             |
|                             | A |   |     |                             |
|                             | q |   |     |                             |
|                             | u |   |     |                             |
|                             | i |   |     |                             |
|                             | f |   |     |                             |
|                             | e |   |     |                             |
|                             | r |   |     |                             |
|                             | A |   |     |                             |
|                             | l |   |     |                             |
|                             | l |   |     |                             |
|                             | u |   |     |                             |
|                             | v |   |     |                             |
|                             | i |   |     |                             |
|                             | a |   |     |                             |
|                             | l |   |     |                             |
|                             |   |   |     |                             |
|                             | P |   |     |                             |
|                             | e |   |     |                             |
|                             | r |   |     |                             |
|                             | c |   |     |                             |
|                             | h |   |     |                             |
|                             | e |   |     |                             |
|                             | d |   |     |                             |
|                             | ( |   |     |                             |
|                             | I |   |     |                             |
|                             | n |   |     |                             |
|                             | t |   |     |                             |
|                             | e |   |     |                             |
|                             | r |   |     |                             |
|                             | m |   |     |                             |
|                             | e |   |     |                             |
|                             | d |   |     |                             |
|                             | i |   |     |                             |
|                             | a |   |     |                             |
|                             | t |   |     |                             |
|                             | e |   |     |                             |
|                             | ) |   |     |                             |
|                             | V |   |     |                             |
|                             | a |   |     |                             |
|                             | d |   |     |                             |
|                             | o |   |     |                             |
|                             | s |   |     |                             |
|                             | e |   |     |                             |
|                             |   |   |     |                             |
|                             | O |   |     |                             |
|                             | t |   |     |                             |
|                             | h |   |     |                             |
|                             | e |   |     |                             |
|                             | r |   |     |                             |
|                             | ( |   |     |                             |
|                             | d |   |     |                             |
|                             | e |   |     |                             |
|                             | s |   |     |                             |
|                             | c |   |     |                             |
|                             | r |   |     |                             |
|                             | i |   |     |                             |
|                             | b |   |     |                             |
|                             | e |   |     |                             |
|                             | ) |   |     |                             |
+-----------------------------+---+---+-----+-----------------------------+
| Completed Borehole / Well   |   |   |     |                             |
| Information                 |   |   |     |                             |
+-----------------------------+---+---+-----+-----------------------------+
| Borehole Diameter:          |   |   | S   |                             |
|                             |   |   | urf |                             |
| Total Depth:                |   |   | ace |                             |
|                             |   |   | S   |                             |
| Casing Diameter:            |   |   | eal |                             |
|                             |   |   | L   |                             |
| Casing Length:              |   |   | eng |                             |
|                             |   |   | th: |                             |
|                             |   |   |     |                             |
|                             |   |   | A   |                             |
|                             |   |   | nnu |                             |
|                             |   |   | lar |                             |
|                             |   |   | S   |                             |
|                             |   |   | eal |                             |
|                             |   |   | L   |                             |
|                             |   |   | eng |                             |
|                             |   |   | th: |                             |
|                             |   |   |     |                             |
|                             |   |   | Fil |                             |
|                             |   |   | ter |                             |
|                             |   |   | P   |                             |
|                             |   |   | ack |                             |
|                             |   |   | L   |                             |
|                             |   |   | eng |                             |
|                             |   |   | th: |                             |
|                             |   |   |     |                             |
|                             |   |   | Scr |                             |
|                             |   |   | een |                             |
|                             |   |   | L   |                             |
|                             |   |   | eng |                             |
|                             |   |   | th: |                             |
|                             |   |   |     |                             |
|                             |   |   | Bl  |                             |
|                             |   |   | ank |                             |
|                             |   |   | L   |                             |
|                             |   |   | eng |                             |
|                             |   |   | th: |                             |
+-----------------------------+---+---+-----+-----------------------------+
|                             |   |   |     |                             |
+-----------------------------+---+---+-----+-----------------------------+
| SOP-05.01                   |   |   |     | Los Alamos                  |
|                             |   |   |     |                             |
|                             |   |   |     | Environmental Restoration   |
|                             |   |   |     | Project                     |
+-----------------------------+---+---+-----+-----------------------------+