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Casings <br /> Wall Outside Slot Size <br /> Casing Depth from Surface Screen <br /> # Fee'to Fee' Casing Type Material Casings Specifications Thickness Diameter Tif any Description <br /> ype <br /> (Inches) (inches) (Inches) <br /> 1 0 140 Blank PVC OD.8 625 in. 1 0 5 8.625 <br /> Thickness:0.500 in <br /> 1 140 170 Screen PVC OD.8.625 in. 1 0.5 8.625 Milled 005 <br /> Thickness 0.500 in. Slots <br /> 1 170 176 Blank PVC OD.8.625 in 1 0 5 8.625 <br /> Thickness.0.500 in. <br /> 1 176 186 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 /> Fee:to Fee: <br /> 0 111 Cement Other Cement NEAT CEMENT W/5%BENTONITE <br /> 111 115 Cement 10 3 Sack Mix CEMENT GROUT <br /> 115 116 Other Fill See description. FINE SAND TRANSITION <br /> 116 186 Filter Pack 8 x 16 GRAVEL ENVELOPE <br /> Other Observations: <br /> Borehole Specifications Certification Statement <br /> Depth from I.the undersigned,certify that tnis report is complete and accurate to the best of my knowledge and relief <br /> Surface Borehole Diameter(inches) Name WELL INDUSTRIES INC <br /> Fee;to Feet <br /> 0 186 17.5 Person.Firm or Corporation <br /> 3282 HIGHWAY 32 CHICO CA 95973 <br /> Address City State <br /> Signed electronic signature received 09/11/2018 812678 <br /> C-57 Licensed Water Weil Contractor Date Signed C-57 License Number <br /> DWR Use Only <br /> CSG# State Well Number Site Code Local Well Number <br /> N I I I W <br /> Latitude Deg/Min/Sec Longitude DeglMinlSec <br /> TRS: <br /> APN: <br /> Form DWR 188 rev. 12/19/2017 Page 2 of 2 <br />