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Casings <br /> Casing Depth from Surface Wall Outside Slot SizeScreen <br /> # Feet to Feet Casing Type Material Casings Specificatons Thickness Diameter Tif any Description <br /> Type(inches) (inches) (inches) <br /> 1 0 156 Blank PVC OD:4.500 in. 1 0.337 4.5 SCH 80 <br /> Thickness:0.337 in. <br /> 1 156 176 Screen PVC OD:4.500 in. 1 0.337 4.5 Milled 0.04 <br /> Thickness:0.337 in. Slots <br /> 1 176 186 Blank PVC OD:4.500 in. 1 0.337 4.5 <br /> Thickness:0.337 in. <br /> 1 186 210 1 No Casing Other N/A NO CASING <br /> Installed <br /> Annular Material <br /> Depth from <br /> Surface Fill Fill Type Details Filter Pack Size Description <br /> Feet to Feet <br /> 0 136 Cement Other Cement NEAT CEMENT W/5%BENTONITE <br /> 136 140 Cement 10.3 Sack Mix CEMENT GROUT <br /> 140 141 Other Fill See description. FINE SAND TRANSITION <br /> 141 190 Filter Pack 8 x 16 GRAVEL ENVELOPE <br /> 190 193 Bentonite High Solids BENTONITE SEAL <br /> 193 1 210 Cement 10.3 Sack Mix CEMENT GROUT <br /> Other Observations: <br /> 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 WELL INDUSTRIES INC <br /> Feet to Feet <br /> 0 210 10.75 Person,Firm or Corporation <br /> 3282 HIGHWAY 32 CHICO CA 95973 <br /> Address City State Zip <br /> Signed electronic signature received 09/11/2018 812678 <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 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 />