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Casings <br /> Wall Outside Screen Slot Size <br /> Casing Depth from Surface <br /> Casing Type Material Casings Specificatons Thickness Diameter if any Description <br /> # Feet to Feet (inches) (inches) Type (inches) <br /> 1 0 380 Blank Low Carbon N/A 0.25 16 <br /> Steel <br /> 2 380 560 Screen Low Carbon N/A 0.25 16 Milled 0.08 <br /> Steel Slots <br /> Annular Material <br /> Depth from <br /> Surface Fill Fill Type Details Filter Pack Size Description <br /> Feet to Feet <br /> 0 50 Cement 10.3 Sack Mix <br /> 50 1 560 Other Fill See description. BIRDS EYE GRAVEL <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 MASELLIS DRILLING INC <br /> Feet to Feet <br /> Person, Firm or Corporation <br /> 0 600 24 <br /> 119 ALBERS ROAD MODESTO CA 95357 <br /> Address City State Zip <br /> Signed electronic signature received 10/27/2022 668622 <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 />