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201 308 CLAY <br /> 308 340 SAND <br /> 340 351 SHALE <br /> 351 352 SAND <br /> 352 398 SHALE <br /> 398 415 SAND AND GRAVEL <br /> 415 460 CLAY <br /> Casings <br /> Casing Depth from Surface Wall Outside Screen Slot Size <br /> # Feet to Feet Casing Type Material Casings Specifications Thickness Diameter if any Description <br /> (inches) (inches) Type (inches) <br /> 1 0 300 Blank PVC OD: 12.750 in. I SDR: 0.606 12.75 <br /> 21 1 Thickness:0.606 <br /> in. <br /> 2 300 420 Screen PVC OD: 12.750 in. I SDR: 0.606 12.75 Saw 0.045 <br /> 21 1 Thickness:0.606 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 56 Cement 10.3 Sack Mix <br /> 56 420 Other Fill See description. BIRDS EYE 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 1 460 21 <br /> Person, Firm or Corporation <br /> 119 ALBERS ROAD MODESTO CA 95357 <br /> Address City State Zlp <br /> Signed electronic signature received 02/25/2020 668622 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> Attachments DWR Use Only <br /> 19685 Harrold Ave Escalon.pdf-Location Map CSG# State Well Number =Site Code Local Well Number <br /> Image_00640.pdf-Permit <br /> N TW <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 />