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�orehole�Sp�cificatrolns '= �ertfficat�oln Statement' <br /> f164 <br /> .,. _:. ...:. .. oz ._....... ,a.. :.:. .,..:.. ....... .. ..... s" ! :-^...�;,.zZ'> 3'i•°�. x... 'a'.,.., .'1rs�g, ..�� uf 3a. ,.^�. _5aa,•. ran..±... tl :�;... <br /> Depth from 1,the undersigned,certify OW 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 /> 1930 LADD RD MODESTO CA 95356 <br /> Address City State <br /> Signed electronic signature received 05/08/2024 290813 <br /> 657 Licensed Water Well Contractor Date Signed 657 Ucense Number <br /> 'R` WR L1re OtVY <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 <br />