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195 <br />216 <br />CLAY <br />216 <br />223 <br />SAND <br />223 <br />245 <br />SHALE <br />245 <br />247 <br />SAND <br />247 1 <br />255 <br />1 SHALE <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 />119 ALBERS ROAD MODESTO CA 95357 <br />(inches) <br />(inches) <br />T <br />Type <br />(inches) <br />Signed electronic signature received 08/08/2022 668622 <br />1 <br />0 <br />210 <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 />210 <br />250 <br />Screen <br />PVC <br />OD: 6.900 in. 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 Fill Type Details <br />Filter Pack Size <br />Description <br />0 100 <br />Bentonite High Solids <br />Name MASELLIS DRILLING INC <br />Feet to Feet <br />100 1 250 <br />Other Fill See description. <br />0 255 <br />GRIT SAND <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 />0 255 <br />11 <br />119 ALBERS ROAD MODESTO CA 95357 <br />Address City State Zip <br />Signed electronic signature received 08/08/2022 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 />