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Borehole Specfficatlons ..' � ;fir, -Certlflcatlon Statement <br /> Depth from 6 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 /> 0 14 36 Person,Firm or Corporation <br /> 14 260 22 1930 LADD RD MODESTO CA 95356 <br /> 260 500 8 Address City State <br /> Signed electronic signature received 08/11/2021 290813 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> "y f■■t�/ <br /> - !+<R�ti �e�I Ir"s i{.fa Fsi{�� t.iE;ipfis' <br /> CSG#! State Well Number Site Code Local Well Number <br /> NI I I :w] <br /> Latitude Deg/Min/Sec Longitude Deg/Min/Sec <br /> TRS: <br /> APN: <br /> Form DWR 188 rev. 12/19/2017 Page 3 of 3 <br />