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Borehole S tcificattonsa s Ceftl catloin Sta emeht '{i i=`t f r ,err <br /> t , <br /> p x <br /> : <br /> Depth from I,the undersigned,certify that this report Is complete and accurate to the beat 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 �Ip— <br /> Signed electronic signature received 02/15/2022 290813 <br /> C-57 Licensed Water Well Contractor Dale Signed C-57 License Number <br /> CSG# State Well Number Site Code Local Well Number <br /> N JW] <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 />