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Casings `> f <br /> Wali outside slot Size <br /> Casing Depth from Surface Screen <br /> # Feet to Feet Casing Type Malarial Casings Speclflcatons Thickness Diameter Type if any Description <br /> (inches) (inches) (inches) <br /> 1 0 127 Blank PVC OD:12.750 in.I SDR: 0.606 12.75 <br /> 211 Thickness:0.606 <br /> In. <br /> 1 127 167 Screen PVC OD:12.750 In.I SDR: 0.606 12.75 Saw 0.085 <br /> 211 Thickness:0.506 Cut <br /> in. <br /> Annular Material <br /> Depth from <br /> Surface Fill Fill Type Details Filter Pack Size Description <br /> Feet to Feet <br /> 0 50 Cement 10.3 Sack Mix <br /> 50 1 167 Fitter Pack Other Gravel Pack No 6 sand pack <br /> Other Observations: <br /> Boreholej Specifications Certificatidm Statement <br /> Depth from I.the undersigned,certify that this report Is complete and accurate to the bast of my knoMedge and befief <br /> Surface Borehole Diameter(Inches) Name HENNINGS BROS DRILLING CO INC <br /> Feet to Feet <br /> 0 167 22 Person,Firm or Corporation <br /> 1930 LADD RD MODESTO CA 95356 <br /> Address City State p <br /> Signed electronic signature received 05/08/2018 290813 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> DWR,Use:'OI'll <br /> CSG# State Well Number Site Code Local Well Number <br /> NEl I I i W <br /> Latitude Deg/Min/Sec Longitude Deg/Min/Sec <br /> TRS: <br /> APN: <br /> Form DWR 188 rev. 12/19/2017 Page_L of <br />