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BoreholeSpecifications ._ . }, >, 4� , cation-Staten�ertlr �M <br /> {{ j: <br /> ?Sr"5 �l3 '�klLa(�_tS,o•A.S• ',�x ;,:`; �Etii -..`,figi :F?,.a M s'�1 .. ¢v Y�I .,% ..., f . <br /> Depth from 1.the undersigned,eerdfy that thla report Is complete and sca rate 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 /> 1930 LADD RD MODESTO CA 95356 <br /> Address City State <br /> Signed electronic signature received 10/14/2021 290813 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> DWit Use Orly <br /> CSG# State Well Number Site Code Local Well Number <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 />