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r <br /> Other Observations: <br /> Borehole Specifications Certification Statement <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 MAGGIORA BROS DRILLING INC <br /> Feet to Feet <br /> 0 30 42 Person,Firm or Corporation <br /> 30 405 28 595 AIRPORT BLVD WATSONVILLE CA 95076 <br /> 405 800 26 Address City State Zip <br /> Signed electronic signature received 09/21/2022 249957 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> DWR Use Only <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 3 of 3 <br />