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�SI1�9 <br /> 1 <br /> well outside Slot Size <br /> Casing Depth from Surface Screen <br /> # Feet to Feet CasEng Type Material Casings Speciftcatons Thickness Diameter Type any Description <br /> (inches) (inches) (inches) <br /> 1 0 200 Blank PVC OD:8.625 in.i SDR: 0.41 8.625 <br /> 211 Thickness:0.410 <br /> in. <br /> 1 200 240 Screen PVC OD:8.625 in.i SDR: 0.41 8.625 Saw 0.05 <br /> 21 Thickness:0.410 Cut <br /> in. <br /> A ula <br /> ateralE <br /> nn" r s _ <br /> ... .. _ .--.. ... ,'.t.. ., c:-. .. � r•: . .. ....:�x...Q,:sa±. :i+f.... ...»r r$.»=t.N''_ �i.. r.» ,4.'•...,r, 2�3 <br /> Depth from <br /> Surface Fill Fill Type Details Filter Pack Size Description <br /> Feet to Feet <br /> 0 100 Bentonite High Solids <br /> 100 240 Filter Pack Other Gravel Pack No 6 sand pack <br /> Other Observations: <br /> Borehole Specificiiolis <br /> . _, E _ �..iI =t CerEtflea%frQn Statement,= <br /> l = k <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 HENNINGS BROS DRILLING CO INC <br /> Feet to Feet <br /> Person,Firm or Corporation <br /> 0 240 14 <br /> 1930 LADD RD MODESTO CA 95356 <br /> Address City State <br /> Signed electronic signature received 04/28/2023 290813 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> DWR Use In <br /> CSG# State Well Number Site Code Local Well Number <br /> N I I—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 />