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Casings <br />Casing <br />Depth from Surface <br />Casing 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 />See description. <br />BIRDS EYE GRAVEL <br />(inches) <br />(inches) <br />Type <br />(inches) <br />Signed electronic signature received 08/17/2022 668622 <br />1 <br />0 <br />40 <br />Blank <br />PVC <br />OD: 6.900 in. I SDR: <br />0.329 <br />6.9 <br />N W <br />Latitude Deg/Min/Sec Longitude Deg/Min/Sec <br />TRS: <br />APN: <br />21 1 Thickness: 0.329 <br />in. <br />2 <br />40 <br />60 <br />Screen <br />PVC <br />OD: 6.900 in. I SDR: <br />0.329 <br />6.9 <br />Saw <br />0.045 <br />21 1 Thickness: 0.329 <br />Cut <br />in. <br />Annular Material <br />Depth from <br />Surface <br />Feet to Feet <br />Fill <br />Fill Type Details <br />Filter Pack Size <br />Description <br />0 20 <br />Cement <br />10.3 Sack Mix <br />Person, Firm or Corporation <br />20 1 60 <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 65 <br />11 <br />119 ALBERS ROAD MODESTO CA 95357 <br />Address City State Zip <br />Signed electronic signature received 08/17/2022 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 2 of 2 <br />