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78 79 CLAY <br /> 79 80 SAND <br /> 80 83 BLUE CLAY <br /> 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 60 Blank PVC OD:6.625 in. I SDR: 0.316 6.625 <br /> 21 1 Thickness:0.316 <br /> in. <br /> 2 60 80 Screen PVC OD:6.625 in. I SDR: 0.316 6.625 Saw 0.045 <br /> 21 1 Thickness:0.316 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 28 Cement 10.3 Sack Mix <br /> 28 1 80 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 /> 0 1 83 12 <br /> Person, Firm or Corporation <br /> 119 ALBERS ROAD MODESTO CA 95357 <br /> Address City State <br /> Signed electronic signature received 10/09/2019 668622 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> Attachments DWR Use Only <br /> Image_00340.pdf-Permit CSG# State Well Number Site Code Local Well Number <br /> 8751 W. Eight Mile Rd Stockton.pdf-Location Map <br /> N UW <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 />