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Borehole Specifications Certification Statement <br /> Depth from ].the undersigned,certify that this report is complete and acwmte to the best of my knowledge and beflef <br /> Surface Borehole Diameter(Inches) Name HENNINGS BROS DRILLING CO INC <br /> Feet to Feet <br /> Person,Finn or Corporation <br /> 1930 LADD RD MODESTO CA 95356 <br /> Address City State <br /> Signed electronic signatures received 06/13/2018 290813 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 license Number <br /> Attg(chments DWR Use Only <br /> Lewis Man.Corp.Plot Map.pdt-Location Map CSG# State Well Number Site Code Local Well Number <br /> —FNI El i I I i 1W1 <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 />