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Other Observations: <br /> Borehole Specifications Certification Statement <br /> Depth from I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> Surface Borehole Diameter(inches) Name AMERICAN CONSTRUCTION AND SUPPLY INC <br /> Feet to Feet <br /> 0 15 10 Person,Firm or Corporation <br /> 45 San Clemente Drive,Suite A-100 CORTE CA 94925 <br /> Address City State Zip <br /> Signed electronic signature received 09/11/2019 310599 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> Attachments DWR Use Only <br /> DWR-WCR-19TMP-013099-0845-C942-Zuckerman- CSG# State Well Number Site Code Local Well Number <br /> McDonald lsland.pdf-Other <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 />