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Borehole Specifications Certification Statement <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 FOX LOOMIS INCORPORATED <br /> Feet to Feet <br /> Person, Firm or Corporation <br /> 6901 MC COMBER STREET SACRAMENTO CA 95828 <br /> Address City State Zip <br /> Signed electronic signature received 05/07/2019 372314 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> DWR Use Only <br /> CSG# State Well Number Site Code Local Well Number <br /> N 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 />