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Casin sr .: <br /> Nv- <br /> Casing Depth from Surface wan Outside Screen Slot Size <br /> # Feet to Feet Casing Type Material Casings Specificatons Thickness Diameter Type if any Description <br /> (inches) (inches) (inches) <br /> 1 0 255 Blank PVC OD:8.625 in.I SDR: 0.41 8.625 <br /> 21'1 Thickness:0.410 <br /> in, <br /> 1 255 275 Screen PVC OD:8,625 in,I SDR: 0.41 8,625 Saw 0.05 <br /> 21 1 Thickness:0.410 Cut <br /> in, <br /> ]'uI.air::Mae�"ialPS LE 3 jrAIN,r'+"' <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 1 275 Filter Pack Other Gravel Pack No 6 sand pack <br /> Other Observations: <br /> Borehole Speclficatiolris 21r� Ce'rt�fication Statement , <br /> v.Y r._.F3 x ..7".',t� <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 /> 0 275 14 Person,Firm or Corporation <br /> 275 283 8 1930 LADD RD MODESTO CA 95356 <br /> Address City State <br /> Signed electronic signature received 08/11/2023 290813 <br /> C-57 Licensed Water Well <br /> �Contractor <br /> A/Date Signed C-57 License Number <br /> �Irg <br /> CSG# State Well Number Site Code Local Well Number <br /> N I 7W] <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 />