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......,.,r+*i t s: ..e ,i3u ..:.:• rtl:.. ': ,plS. Ti .�f i. ;.:"' , •:.1..`t Y.(1..:5 i St! ftf,.l J t- if ! f <br /> ....,....:a:u?•::;:*,c.ri=sse.�.,z ... >�,-..I,::�f - ar:,:,.,.,• '- t, Mir,onts W f' <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 /> 1930 LADD RD MODESTO CA 95356 <br /> Address City State <br /> Signed electronic signature received 05/18/2022 290813 <br /> C-57 Licensed Water Well Contractor Date Signed C57 License Number <br /> ; use .:," <br /> CSG# State Well Number Site Code Local Well Number <br /> i T-i I I I N I I W <br /> Latitude Deg/Min/Sec Longitude Deg/Min/Sec <br /> TRS: <br /> APN: <br /> Form DWR 188 rev. 12/19/2017 Page_j of 2 <br />