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170 172 CLAY <br /> 172 186 SAND <br /> 186 190 BLUE CLAY <br /> 190 195 SAND <br /> 195 216 CLAY <br /> 216 243 SAND <br /> 243 246 BLUE CLAY <br /> 246 248 SAND <br /> 248 253 CLAY <br /> 253 1 280 SAND <br /> Casings <br /> Casing Depth from Surface Wall Outside Screen Slot Size <br /> p Feet to Feet Casing Type Material Casings Specificatons Thickness Diameter Type if any Description <br /> (inches) (inches) (inches) <br /> 1 0 215 Blank Other N/A 0.25 16 <br /> 2 215 275 Screen Other N/A 0.25 16 Milled 0.08 <br /> 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 1 275 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 /> 280 24 Person,Firm or Corporation <br /> 0 <br /> 119 ALBERS ROAD MODESTO CA 95357 <br /> Address City State Zip <br /> Signed electronic signature received 03/06/2023 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 I I I I I I JW � <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 />