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290 292 BLACK SAND <br /> 292 305 SHALE <br /> 305 320 BLACK SAND <br /> Casings <br /> Casing Depth from Surface Wall Outside Screen Slot Size <br /> # Feet to Feet Casing Type Material Casings Specificatons Thickness Diameter Tif any Description <br /> Type(inches) (inches) (inches) <br /> 1 0 180 Blank PVC OD:8.625 in. I SDR: 0.41 8.625 <br /> 21 1 Thickness:0.410 <br /> in. <br /> 2 180 200 Screen PVC OD:8.625 in. I SDR: 0.41 8.625 Saw 0.045 <br /> 21 1 Thickness:0.410 Cut <br /> in. <br /> 3 200 300 Blank PVC OD:8.625 in. I SDR: 0.41 8.625 <br /> 21 1 Thickness:0.410 <br /> in. <br /> 4 300 320 Screen PVC OD:8.625 in. I SDR: 0.41 8.625 Saw 0.045 <br /> 21 1 Thickness:0.410 Cut <br /> in. <br /> Annular Material <br /> Depth from <br /> Surface Fill Fill Type Details Filter Pack Size Description <br /> Feet to Feet <br /> 0 50 Bentonite High Solids <br /> 50 1 320 Other Fill See description. BIRDSEYE GRAVEL <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 MASELLIS DRILLING INC <br /> Feet to Feet <br /> 0 320 14 Person,Firm or Corporation <br /> 119 ALBERS ROAD MODESTO CA 95357 <br /> Address City State Zip <br /> Signed electronic signature received 02/18/2020 668622 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> Attachments DWR Use Only <br /> Image_00624.pdf-Other CSG# State Well Number Site Code Local Well Number <br /> Image_00623.pdf-Permit <br /> 17020 Henry Rd Escalon.pdf-Location Map <br /> FN 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 />