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Boreho4e�pectf1ca ator�s - ''Certifi�ca Iaaternent t <br /> 1 ," rr „;:dir,R�F,.fi .+"` krrSxA: fkMrdsma? iM�"'r..+°e ?..aH _ s ?�€ .ti'a'M� ¢ i <br /> .r, <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 CANEPA AND SONS INC <br /> Feet to Feet <br /> Person,Firm or Corporation <br /> 14384 CUESTA COURT SONORA CA 95370 <br /> Address City State Zip <br /> Signed electronic signature received 12/29/2020 425749 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> qg-[y <br /> �t�i�FMIfiP�i MKI <br /> MT, � � ��M �5r "``m`3€ <br /> CSG# State Well Number Site Code Local Well Number <br /> NF-� I jw � <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 />