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Casings <br /> Casing Depth from Surface Wall Outside Screen Slot Size <br /> # Feet to Feet Casing Type Material Casings Specificatons Thickness Diameter Type if any Description <br /> (inches) (inches) (inches) <br /> 1 0 230 Blank PVC OD:8.625 in.I SDR: 0.41 8.625 <br /> 211 Thickness:0.410 <br /> in. <br /> 1 230 270 Screen PVC OD:8.625 in.I SDR: 0.41 8.625 Saw 0.05 <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 /> 0 200 Bentonite High Solids <br /> 200 1 270 Filter Pack Other Gravel Pack No 6 sand pack <br /> Other Observations: <br /> Borehole Specifications Certification State6ient <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 HENNINGS BROS DRILLING CO INC <br /> Feet to Feet <br /> 0 et 14 Person,Finn or Corporation <br /> 1930 LADD RD MODESTO CA 95356 <br /> Address City State <br /> Signed electronic signature received 09/24/2019 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 JW <br /> Latitude Deg/Min/Sec Longitude Deg/Min/Sec <br /> TRS: <br /> APN: <br /> Form DWR 188 rev. 12/19/2017 Page_I of 2 <br />