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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 if any Description <br /> (inches) (inches) Type (inches) <br /> 1 0 183 Blank PVC OD:6.625 in. I SDR: 0.316 6.625 <br /> 21 1 Thickness:0.316 <br /> in. <br /> 2 183 203 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 /> 0 100 Bentonite High Solids <br /> 100 1 203 Other Fill See description. GRAVEL <br /> Other Observations: <br /> Borehole Specifications Certification Statement <br /> Depth from L 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 1 220 12 Person, Firm or Corporation <br /> 119 ALBERS ROAD MODESTO CA 95357 <br /> Address City State Zip <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 /> Image_00642.pdf-Permit CSG# State Well Number =Site Code Local Well Number <br /> 830 Woodbridge Rd Lodi.pdf-Location Map <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 />