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Casings <br />Casing <br />Depth from Surface <br />Description <br />63 78 Filter Pack <br />8 x 20 #3 <br />Wall <br />Outside <br />Screen <br />Slot Size <br />60 63 Bentonite <br /># <br />Feet to Feet <br />Casing Type <br />Material <br />Casings Specificatons <br />Thickness <br />Diameter <br />T <br />Type <br />if any <br />Description <br />C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br />DWR Use Only <br />Attachments <br />MW551 B Well Diagram & Boring Log.pdf - Geologic Log <br />(inches) <br />(inches) <br />(inches) <br />1 <br />7—F76 <br />TRS: <br />Blank <br />PVC <br />OD: 4.500 in. 1 <br />0.337 <br />4.5 <br />Milled <br />0.02 <br />10 feet of screen <br />Thickness: 0.337 in. <br />Slots <br />Annular Material <br />Depth from <br />Surface Fill <br />Feet to Feet <br />Fill Type Details Filter Pack Size <br />Description <br />63 78 Filter Pack <br />8 x 20 #3 <br />Borehole Diameter (inches) <br />0 60 Cement <br />Portland Cement/Neat Cement <br />60 63 Bentonite <br />High Solids <br />10 <br />Other Observations: <br />Borehole Specifications <br />Certification Statement <br />Depth from <br />I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief <br />Surface <br />Borehole Diameter (inches) <br />Name CONFLUENCE TECHNICAL SERVICES INC <br />Feet to Feet <br />Person, Firm or Corporation <br />10 <br />,--7778 <br />6821 8th Street Rio Linda CA 95673 <br />Address City State Zip <br />Signed electronic signature received 11/28/2023 1035255 <br />C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br />DWR Use Only <br />Attachments <br />MW551 B Well Diagram & Boring Log.pdf - Geologic Log <br />CSG # State Well Number Site Code Local Well Number <br />N <br />[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 />