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180 <br />187 <br />BROWN CLAY <br />187, <br />198 <br />BROWN SAND <br />198 <br />201 <br />BROWN CLAY <br />201 <br />210 <br />BROWN SAND <br />210 <br />295 <br />DARK BLUE CLAY <br />295 1 <br />308 <br />BLUE SAND <br />Other Observations: <br />Casings <br />Certification Statement <br />Depth from <br />Casing <br />Depth from Surface <br />Casing Type <br />Name MASELLIS DRILLING INC <br />Material <br />Casings Specificatons <br />Wall <br />Thickness <br />Outside <br />Diameter <br />Screen <br />Slot Size <br />if any <br />Description <br /># <br />Feet to Feet <br />Address City State Zip <br />Signed electronic signature received 07/21/2021 668622 <br />(inches) <br />(inches) <br />T <br />Type <br />(inches) <br />298 W Bowman Rd French Camp.pdf - Location Map <br />1 <br />0 <br />150 <br />Blank <br />Image_02683.pdf - Permit <br />PVC <br />OD: 10.750 in. I SDR: <br />0.511 <br />10.75 <br />TRS: <br />APN: <br />21 1 Thickness: 0.511 <br />in. <br />2 <br />150 <br />210 <br />Screen <br />PVC <br />OD: 10.750 in. I SDR: <br />0.511 <br />10.75 <br />Saw <br />0.045 <br />21 i Thickness: 0.511 <br />Cut <br />in. <br />Annular Material <br />Depth from <br />Surface <br />Fill <br />Fill Type Details <br />Filter Pack <br />Size <br />Description <br />Feet to Feet <br />0 110 <br />Bentonite <br />High Solids <br />110 1 210 <br />1 Other Fill <br />I See description. <br />BIRDS EYE GRAVEL <br />Other Observations: <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 />0 308 <br />18 <br />119 ALBERS ROAD MODESTO CA 95357 <br />Address City State Zip <br />Signed electronic signature received 07/21/2021 668622 <br />C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br />DWR Use Only <br />Attachments <br />298 W Bowman Rd French Camp.pdf - Location Map <br />umber Site Code <br />CSG # State Well Number= <br />Local Well Number <br />Image_02683.pdf - Permit <br />F-1 -]A- IN IWI <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 />