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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 /> Annular Material <br /> Depth from <br /> Surface Fill Fill Type Details Filter Pack Size Description <br /> Feet to Feet <br /> Destruction Details: <br /> Borehole advanced to a total depth of 40 feet below ground surface. Borehole backfilled with neat cement grout via tremie pipe from full depth to the surface. <br /> Grout was mixed at a ratio of 3 gallons of water per 47-Ib bag of cement.A total of 10 gallons of grout was used, requiring approximately 2 bags of cement. <br /> Top of borehole topped off with quick-set concrete. <br /> Other Observations: <br /> Groundwater,if encountered,was not measured. <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 KLEINFELDER INC <br /> Feet to Feet <br /> 0 40.3 2 Person, Firm or Corporation <br /> 550 WEST C STREET STE 1200 SAN DIEGO CA 92101 <br /> Address City State Zip <br /> Signed electronic signature received 11/12/2020 467252 <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 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 />