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Annular Material <br />Depth from Surface <br />(Feet to Feet) Fill Fill Type Details Filter Pack Size Description <br />0 200 Bentonite High Solids <br />200 405 Other Fill See description BIRDS EYE PEA GRAVEL <br />Other Observations: <br />Borehole Specifications <br />Depth from Surface <br />(Feet to Feet) <br />Borehole Diameter <br />(inches) <br />0 405 16 <br />Certification Statement <br />I, the undersigned, certify that this report is complete and accurate to the best of my knowledge <br />and belief. <br />Name: CANEPA AND SONS INC <br />Person, Firm or Corporation <br />14384 CUESTA COURT <br />Address <br />SONORA <br />City <br />California <br />State <br />95370 <br />Zip <br />Signed: electronic signature received <br />C-57 Licensed Water Well Contractor <br />08/25/2026 <br />Date Signed <br />425749 <br />License Number <br />DWR Use Only <br />CSG # State Well Number Site Code Local Well Number <br />---- ---- ---- N <br />Latitude Deg/Min/Sec <br />---- ---- ---- W <br />Longitude Deg/Min/Sec <br />APN: ---- <br />Township: ---- <br />Section: ---- <br />SEQ: ---- <br />Range: ---- <br />Tract: ---- <br />BM: ---- <br />Attachments <br />No Attachments <br />DWR Form 188 rev 10/09/2025 Page 3 of 3