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Borehole Specifications L' CertiiflcationlStatemeht <br />Depth from <br />Surface <br />Feet to Feet <br />Borehole Diameter (inches) <br />I, the undersigned, certify that this report is complete and accurate to the t>est of my Imowledge and lielief <br />Name HENNINGS BROS DRILLING CO INC <br />Person, Firm or Corporation <br />1930 LADD RD <br />Address <br />MODESTO <br />city <br />CA <br />State <br />95356 <br />Zip <br />Signed electronic signature received 09/01/2022 290813 <br />C-57 Licensed Water Weil Contractor Date Signed 0-57 License Number <br />) .'if, <br />-i"'' L' <br />CSG#State Well Number Site Code <br />! ' i'ti' • <br />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 ^ of ^