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Borehole, Specifications Certification Statement;J <br />Depth from <br />Surface <br />Feet to Feet <br />Borehole Diameter (Inches) <br />I, the undersigned, certify Uiat this report is complete snd accurate to the liest of my knowledge and iielief <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 />"2ir" <br />Signed electronic signature received 10/18/2022 290813 <br />C-57 Licensed Water Well Contractor Date Signed 0-57 License Number <br />' IA ' If."'\-ij, If"-.DWR;Use.6rily' <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