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345 <br />360 <br />SAND & GRAVEL <br />360 <br />380 <br />SHALE <br />380 <br />383 <br />SAND <br />383 <br />397 <br />CLAY <br />397 <br />404 <br />SAND <br />404 <br />412 <br />SHALE <br />412 <br />414 <br />SAND <br />414 <br />425 <br />SHALE <br />425 <br />430 <br />SAND <br />430 <br />446 <br />SHALE <br />446 <br />456 <br />SAND <br />456 <br />480 <br />SHALE <br />Casings <br />Casing <br />Depth from Surface <br />200 Bentonite High Solids <br />200 <br />1 460 Other Fill See description. BIRDS EYE GRAVEL <br />Wall <br />Outside <br />Screen <br />Slot Size <br />Person, Firm or Corporation <br /># <br />Feet to Feet <br />Casing Type <br />Material <br />Casings Specificatons <br />Thickness <br />Diameter <br />Type <br />if any <br />Description <br />C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br />DWR Use Only <br />(inches) <br />(inches) <br />Local Well Number <br />(inches) <br />1 <br />0 <br />280 <br />Blank <br />PVC <br />OD: 12.750 in. I SDR: <br />0.606 <br />12.75 <br />APN: <br />21 1 Thickness: 0.606 <br />in. <br />2 <br />280 <br />460 <br />Screen <br />PVC <br />OD: 12.750 in. I SDR: <br />0.606 <br />12.75 <br />Saw <br />0.045 <br />21 1 Thickness: 0.606 <br />Cut <br />in. <br />Annular Material <br />Depth from <br />Surface Fill Fill Type Details Filter Pack Size Description <br />Feet to Feet <br />0 <br />200 Bentonite High Solids <br />200 <br />1 460 Other Fill See description. 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 />0 480 <br />20 <br />119 ALBERS ROAD MODESTO CA 95357 <br />Address City State Zip <br />Signed electronic signature received 10/03/2022 668622 <br />C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br />DWR Use Only <br />CSG #State Well Number <br />Site Code <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 2 of 2 <br />