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...'. .. l• 1. S :� .iF 3: <br /> C ¢ L '�a' .v.� ;7e GC i ..S <br /> Borehole A `eclficafions.:j•1.. .;, :..., x, i <br /> , Certifica iort Statemen <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 HENNINGS BROS DRILLING CO INC <br /> Feet to Feet <br /> Person,Firm or Corporation <br /> 1930 LADD RD MODESTO CA 95356 <br /> Address City State alp <br /> Signed electronic signature received 04/13/2021 290813 <br /> 6-57 Licensed Water Well Contractor Date Signed 6-57 License Number <br /> d,# f= r u DWyi' <br /> CSG# State Well Number Site Code Local Well Number <br /> N I I I I JW] <br /> Latitude Deg/Min/Sec Longitude Deg/Min/Sec <br /> TRS: <br /> APN: <br /> Form DWR 188 rev. 12/19/2017 Page-L of 2 <br />