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Casings <br /> Wall Outside Slot Size <br /> Casing Depth from Surface Screen <br /> # Feet to Feet Casing Type Material Casings Specificatons Thickness Diameter Tif any Description <br /> Type(inches) (inches) (inches) <br /> 1 0 110 Other:Vent PVC OD:2.375 in. I SDR: 0.154 2.375 <br /> SCH 40 1 Thickness: <br /> 0.154 in. <br /> 1 110 300 Other:Vent PVC OD:2.375 in. I SDR: 0.154 2.375 Milled 0.02 <br /> SCH 40 1 Thickness: Slots <br /> 0.154 in. <br /> Annular Material <br /> Depth from <br /> Surface Fill Fill Type Details Filter Pack Size Description <br /> Feet to Feet <br /> 0 103 Cement 10.3 Sack Mix <br /> 103 1 300 Other Fill See description. Asbury 218-L Coke Breeze <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 AMERICAN CONSTRUCTION AND SUPPLY INC <br /> Feet to Feet <br /> 0300 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 04/06/2020 310599 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> Attachments DWR Use Only <br /> DWR-WCR-19TMP-011336-S.Lammers-Tracy.pdf-Other CSG# State Well Number Site Code Local Well Number <br /> N F-Fl- I I I <br /> 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 />