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Borehole Specifications GertificationStatement <br />Depth from <br />Surface <br />Feet to Feet <br />Borehole Diameter (Inches) <br />I, the undersigned, certify that this report is complete and accurate to the liest of my knowledge and lielief <br />Name HENNINGS BROS DRILLING CO INC <br />Person, Firm or Corporation <br />1930 LADD RD <br />Address <br />MODESTO <br />city <br />CA <br />state <br />95356 <br />-w <br />Signed electronic signature received 08/25/2021 290813 <br />C-57 Licensed Water Well Contractor Date Signed 0-57 License Number <br />DWRUsepiily <br />CSG#State Well Number Site Code Local Well Number <br />N W <br />Latitude Deg/M in/Sec Longitude Deg/Min/Sec <br />IRS: <br />APN: <br />Form DWR 188 rev. 12/19/2017 Page 2 of 2