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BorehoieSpecifications Certification Statement <br /> . - .. I,the undersigned,certify that Ws report Is complete and a= _ .. <br /> Depth from Tato to the beat of my knowledge and belief <br /> Surface Borehole Diameter(inches) Name HENNINGS BROS DRILLING CO INC <br /> Feet to Feet <br /> Person,Firm or Corporation <br /> 1930 LADD RD MODESTO CA 95356 <br /> Address City State <br /> Signed electronic signature received 04/30/2018 290813 <br /> C-57 Uoensed Water Well Contractor Date Signed C-57 License Number <br /> DWR Use'Onl�i <br /> CSG#j State Well Number Slte Code Local Well Number <br /> N W <br /> Latitude Deg/Min/Sec Longitude Deg/Min/Sec <br /> TRS: <br /> APN: <br /> Form DWR 188 rev. 12/19/2017 Page 2_of_2- <br />