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Casing Depth from Surface Wall Outside screen Slot sine <br /> # Feet to Feet Casing Type Material Casings Speeifieatons Thickness Diameter Type if any Description <br /> (inches) (inches) (inches) <br /> 1 0 140 Blank PVC OD:12.750 in.I SDR: 0.606 12.75 <br /> 21 Thickness:0.606 <br /> in. <br /> 1 140 200 Screen PVC OD:12.750 in.I SDR: 0.606 12.75 Saw 0.05 <br /> 21 Thickness:0.606 Cut <br /> in. <br /> fA�nul���Material - _ <br /> Depth from <br /> Surface Fill Fill Type Details Filter Pack Size Description <br /> Feet to Feet <br /> 0 50 Cement 10.3 Sack Mix <br /> 50 200 Filter Pack Other Gravel Pack No 6 sand pack <br /> Other Observations: <br /> Borehole:S acificatrons Certification Statement <br /> P _ . ... <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 /> 0 200 22 <br /> 1930 LADD RD MODESTO CA 95356 <br /> Address City State <br /> Signed electronic signature received 09/16/2021 290813 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> CSG# State Well Number Site Code Local Well Number <br /> T—N I—w] <br /> Latitude Deg/Min/Sec Longitude Deg/Min/Sec <br /> TRS: <br /> APN: <br /> Form DWR 188 rev. 12/19/2017 Page_I of 2 <br />