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Other Observations: <br />Borehole Specifications 11 Certification Statement <br />Depth from <br />Surface Borehole Diameter (inches) <br />Feet to Feet <br />I 0 1 185 1 22 1 <br />I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief <br />Name HENNINGS BROS DRILLING CO INC <br />Person, Firm or Corporation <br />1930 LADD RD MODESTO CA 95356 <br />Address City State <br />Signed electronic signature received 03/2112018 290813 <br />C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br />DWR Use Only <br />CSG # State Well Number I Site Code Local Well Number <br />T-1 El I I i N lw� <br />Latitude Deg/Min/Sec <br />TRS: <br />APN: <br />Longitude Deg/Min/Sec <br />Form DWR 188 rev. 12/19/2017 Page 2 of 2 <br />Casings <br />Casing <br />Depth from Surface <br />Feet <br />Casing Type <br />Material <br />Casings Specificatons <br />Wall <br />Thickness <br />Outside <br />Diameter <br />Screen <br />Type <br />Slot Size <br />if any <br />Description <br /># <br />Feet to <br />(inches) <br />(inches) <br />(inches) <br />1 <br />0 <br />125 <br />Blank <br />PVC <br />OD: 12.750 in. I SDR: <br />0.606 <br />12.75 <br />21 1 Thickness: 0.606 <br />in. <br />1 <br />125 <br />185 <br />Screen <br />PVC <br />OD: 12.750 in. I SDR: <br />0.606 <br />12.75 <br />Saw <br />0.085 <br />21 1 Thickness: 0.606 <br />Cut <br />1 <br />in. <br />Annular Material <br />Depth from <br />Surface <br />Fill Fill Type Details <br />Filter Pack <br />Size <br />Description <br />Feet to Feet <br />0 <br />50 <br />Cement 10.3 Sack Mix <br />50 <br />1 185 <br />Filter Pack Other Gravel Pack <br />No. 6 sand pack <br />Other Observations: <br />Borehole Specifications 11 Certification Statement <br />Depth from <br />Surface Borehole Diameter (inches) <br />Feet to Feet <br />I 0 1 185 1 22 1 <br />I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief <br />Name HENNINGS BROS DRILLING CO INC <br />Person, Firm or Corporation <br />1930 LADD RD MODESTO CA 95356 <br />Address City State <br />Signed electronic signature received 03/2112018 290813 <br />C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br />DWR Use Only <br />CSG # State Well Number I Site Code Local Well Number <br />T-1 El I I i N lw� <br />Latitude Deg/Min/Sec <br />TRS: <br />APN: <br />Longitude Deg/Min/Sec <br />Form DWR 188 rev. 12/19/2017 Page 2 of 2 <br />