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Casings' • <br />Casing <br />n <br />Depth from Surface <br />Feet to Feet <br />Casing Type Material Casings Specificatons <br />Wall <br />Thickness <br />(inches) <br />Outside <br />Diameter <br />(inches) <br />Screen <br />Type <br />Slot Size <br />if any <br />(inches) <br />Description <br />1 0 100 Blank PVC OD: 12.750 in. j SDR: <br />21 1 Thickness: 0.606 <br />In. <br />0.606 12.75 <br />1 100 180 Screen PVC OD: 12.750 in. | SDR: <br />21 1 Thickness: 0.606 <br />In. <br />0.606 12.75 Saw <br />Cut <br />0.05 <br />Annular Material <br />Depth from <br />Surface <br />Feet to Feet <br />Fill Fill Type Details Filter Pack Size Description <br />0 50 Cement 10.3 Sack Mix <br />50 180 Filter Pack Other Gravel Pack No 6 sand pack <br />other Observations: <br />Borehole Specifications Certification Statement <br />Depth from <br />Surface <br />Feet to Feet <br />180 <br />180 <br />200 <br />Borehole Diameter (inches) <br />22 <br />I, the undersigned, certify that this report is complete and accurate to the t>est of my Imowledge and l>elief <br />Name HENNINGS BROS DRILLING CO INC <br />Person, Firm or Corporation <br />1930 LADD RD MODESTO OA <br />Address City State <br />Signed electronic signature received 09/16/2021 290813 <br />95356 <br />"ZIT" <br />C-57 Ucensed Water Well Contractor Date Signed 0-57 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 />IRS: <br />APN: <br />Form DWR 188 rev. 12/19/2017 Page ^ of _2_