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;Casings ` x ` <br /> Casing Depth from Surface wall outside Screen Slot Size <br /> # Feet to Feet Casing Type Material Casings Speciflcatons Thickness Diameter Type if any Description <br /> (inches) (inches) (inches) <br /> 1 0 230 Blank PVC OD:6.625 in. I SDR: 0.316 6.625 <br /> 211 Thickness:0.316 <br /> In. <br /> 1 230 250 Screen PVC OD:6.625 in. i SDR: 0.316 6.625 Saw 0.032 <br /> 21 Thickness:0.316 Cut <br /> in. <br /> _'. h Annular Oteri,I ' <br /> 4 <br /> Depth from <br /> Surface Fill Fill Type Details Fitter Pack Size Description <br /> Feet to Feet <br /> 0 110 Bentonite High Solids <br /> 110 250 Filter Pack Other Gravel Pack No 6 sand pack <br /> Other Observations: <br /> Borehole Specifications Certlf cation`Statemenfi "- ;Y <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 HENNINGS BROS DRILLING CO INC <br /> Feet to Feet <br /> Person,Firm or Corporation <br /> 0 250 12 <br /> 1930 LADD RD MODESTO CA 95356 <br /> Address City State <br /> Signed electronic signature received 08/27/2021 290813 <br /> C-57 Licensed Water Well Contractor Dale Signed C-57 License Number <br /> ,..' DWR Use i r <br /> t I1 Y t t l~ t <br /> CSG# State Well Number Site CodeLocal Well Number <br /> N I J: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 />