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Borehole Specifications Certification Statement <br /> Depth from 1,the undersigned,certify that this report is complete and acarate 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 --Zi <br /> Signed electronic signature received 08/22/2018 290813 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> DWR'Use Only <br /> CSG# State Well Number Site Code Local Well Number <br /> N El i I 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 2_of 2— <br />