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Casings <br /> Wall Outside Slot Size <br /> Casing Depth from Surface Screen <br /> # Feet to Feet Casing Type Material Casings Speclficatons Thickness Diameter if any Description <br /> (inches) (inches) Type (inches) <br /> 1 0 187 Blank PVC OD 4 500 in. 1 0 337 4.5 SCH 80 <br /> Thickness:0.337 in <br /> 1 187 197 Screen PVC OD:4 500 in 1 0.337 4.5 Milled 004 SCH 80 <br /> Thickness:0.337 in. Slots <br /> 1 197 204 Blank PVC OD:4.500 in. 1 0.337 4.5 SCH 80 <br /> Thickness 0 337 in <br /> 1 204 207 No Casing Other NiA 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 /> 0 166 Cement Other Cement NEAT CEMENT W/5%BENTONITE <br /> 166 170 Cement 10.3 Sack Mix CEMENT GROUT <br /> 170 171 Other Fill See description. FINE SAND TRANSITION <br /> 171 207 Filter Pack 1 8 x 16 GRAVEL ENVELOPE <br /> Other Observations: <br /> Borehole Specifications Certification Statement <br /> Depth from I the undo•signed.cer,6,that this repor,is comp'e:e and accurate to the best of my knowledge and belief <br /> Surface Borehole Diameter(inches) Name WELL INDUSTRIES INC <br /> Feet to Feet <br /> 0 207 12.25 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 Well Contractor Date Signed C-57 License Number <br /> DWR Use Only <br /> CSG# State Well Number Site Code Local Well Number <br /> N JW <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 />