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168 <br />191 <br />BROWN SAND <br />191 <br />198 <br />BLUE CLAY <br />198 <br />215 <br />BROWN SAND <br />215 <br />280 <br />DARK BLUE CLAY <br />Casings <br />Casing <br />Depth from Surface <br />Casing Te <br />Type <br />Material <br />Casings Specificatons <br />Wall <br />Thickness <br />Outside <br />Diameter <br />Screen <br />Slot Size <br />if any <br />Description <br /># <br />Feet to Feet <br />0 280 <br />14 <br />(inches) <br />(inches) <br />T <br />Type <br />(inches) <br />1 <br />0 <br />198 <br />Blank <br />PVC <br />OD: 8.625 in. I SDR: <br />0.41 <br />8.625 <br />C-57 License Number <br />DWR Use Only <br />CSG # State Well Number Site Code <br />Local Well Number <br />21 1 Thickness: 0.410 <br />N <br />W <br />Latitude Deg/Min/Sec Longitude <br />Deg/Min/Sec <br />TRS: <br />in. <br />2 <br />198 <br />218 <br />Screen <br />PVC <br />OD: 8.625 in. I SDR: <br />0.41 <br />8.625 <br />Saw <br />0.045 <br />21 1 Thickness: 0.410 <br />Cut <br />in. <br />Annular Material <br />Depth from <br />Surface <br />Feet to Feet <br />Fill <br />Fill Type Details Filter Pack Size <br />Description <br />0 158 <br />Bentonite <br />High Solids <br />Name MASELLIS DRILLING INC <br />158 1 218 <br />Other Fill <br />See description. <br />BIRDS EYE GRAVEL <br />Other Observations: <br />Borehole Specifications <br />Certification Statement <br />Depth from <br />I, the undersigned. certify that this report is complete and accurate to the best of my knowledge and belief <br />Surface <br />Borehole Diameter (inches) <br />Name MASELLIS DRILLING INC <br />Feet to Feet <br />Person, Firm or Corporation <br />0 280 <br />14 <br />119 ALBERS ROAD MODESTO <br />CA 95357 <br />Address City <br />State <br />Signed electronic signature received 08/02/2022 <br />668622 <br />C-57 Licensed Water Well Contractor Date Signed <br />C-57 License Number <br />DWR Use Only <br />CSG # State Well Number Site Code <br />Local Well Number <br />N <br />W <br />Latitude Deg/Min/Sec Longitude <br />Deg/Min/Sec <br />TRS: <br />APN: <br />Form DWR 188 rev. 12/19/2017 Page 2 of 2 <br />