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323 325 SAND <br /> 325 360 CLAY <br /> 360 365 SAND <br /> 365 370 GRAVEL <br /> 370 400 1 CLAY <br /> Casings <br /> Wall Outside Screen Slot Size <br /> Casing Depth from Surface <br /> # Feet to Feet Casing Type Material Casings Specificatons Thickness Diameter if any Description <br /> (inches) (inches) Type (inches) <br /> 1 0 300 Blank PVC OD:8.625 in. I SDR: 0.41 8.625 <br /> 21 1 Thickness:0.410 <br /> in. <br /> 2 300 380 Screen PVC OD:8.625 in. I SDR: 0.41 8.625 Saw 0.045 <br /> 21 1 Thickness:0.410 Cut <br /> in. <br /> Annular Material <br /> Depth from <br /> Surface Fill Fill Type Details Filter Pack Size Description <br /> Feet to Feet <br /> 0 206 Bentonite High Solids <br /> 206 1 380 Other Fill See description. GRAVEL <br /> 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 MASELLIS DRILLING INC <br /> Feet to Feet <br /> Person,Firm or Corporation <br /> ,--77 400 14 <br /> 119 ALBERS ROAD MODESTO CA 95357 <br /> Address City State Zip <br /> Signed electronic signature received 08/21/2019 668622 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> Attachments DWR Use Only <br /> 14501 WELLS LN LODI-map.pdf-Location Map CSG# State Well Number Site Code Local Well Number <br /> Image_00165.pdf-Permit <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 />