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206 <br />246 <br />GRAVEL <br />246 <br />249 <br />CLAY <br />249 <br />321 <br />SAND <br />321 <br />351 <br />CLAY <br />351 <br />370 <br />BLUE CLAY <br />370 <br />373 <br />BLUE SAND <br />373 <br />375 <br />BLUE CLAY <br />L!t! servations: <br />Borehole Specifications <br />Casings <br />Depth from <br />I. the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief <br />Casing <br />Depth from Surface <br />Name MASELLIS DRILLING INC <br />Feet to Feet <br />Wall <br />Outside <br />Screen <br />Slot Size <br /># <br />Feet to Feet <br />Casing Type <br />Material <br />Casings Specificatons <br />Thickness <br />Diameter <br />Type <br />if any <br />Description <br />Image_02677.pdf - PermitPHI <br />State Well Number Site Code <br />Local Well Number <br />(inches) <br />(inches) <br />(inches) <br />1 <br />0 <br />190 <br />Blank <br />PVC <br />OD: 12.750 in. I SDR: <br />0.606 <br />12.75 <br />21 1 Thickness: 0.606 <br />in. <br />2 <br />190 <br />310 <br />Screen <br />PVC <br />OD: 12.750 in. I SDR: <br />0.606 <br />12.75 <br />Saw <br />0.045 <br />21 1 Thickness: 0.606 <br />Cut <br />in. <br />Annular Material <br />Depth from <br />Surface <br />Fill Fill Type <br />Details <br />Filter Pack <br />Size <br />Description <br />Feet to Feet <br />0 50 <br />Bentonite High Solids <br />50 1 310 <br />Other Fill See description. <br />BIRDS EYE GRAVEL <br />L!t! servations: <br />Borehole Specifications <br />Certification Statement <br />Depth from <br />I. the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief <br />Surface <br />Borehole Diameter (inches) <br />Name MASELLIS DRILLING INC <br />Feet to Feet <br />Person, Firm or Corporation <br />0375 <br />20 <br />119 ALBERS ROAD MODESTO CA 95357 <br />Address City State Zip <br />Signed electronic signature received 07/20/2021 668622 <br />C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br />DWR Use Only <br />Attachments <br />Image_02677.pdf - PermitPHI <br />State Well Number Site Code <br />Local Well Number <br />33856 S Bevis Rd Tracy.pdf - Location Map <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 />