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'148 <br />163 <br />CLAY <br />163 <br />178 <br />GRAVEL <br />178 <br />232 <br />CLAY <br />232 <br />237 <br />SAND <br />237 <br />247 <br />CLAY <br />247 <br />252 <br />SAND <br />252 <br />261 <br />CLAY <br />261 <br />266 <br />SAND <br />266 <br />295 <br />1 CLAY <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 />.---F—T295 12 Person, Firm or Corporation <br />119 ALBERS ROAD MODESTO CA 95357 <br />Address City State Zip <br />Signed electronic signature received 07/21/2021 668622 <br />C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br />DWR Use Only <br />CSG # State Well Number I Site Code Local Well Number <br />IMMME10ma <br />Latitude Deg/Min/Sec <br />TRS: <br />APN: <br />Longitude Deg/Min/Sec <br />Form DWR 188 rev. 12/19/2017 Page 2 of 2 <br />Casings <br />Casing <br /># <br />Depth from Surface <br />Feet to Feet <br />Casing Type <br />Material <br />Casings Specificatons <br />WallOutside <br />Thickness <br />Diameter <br />Screen <br />Type <br />Slot Size <br />if any <br />Description <br />(inches) <br />(inches) <br />(inches) <br />1 <br />0 <br />245 <br />Blank <br />PVC <br />OD: 6.900 in. I SDR: <br />0.329 <br />6.9 <br />211 Thickness: 0.329 <br />in. <br />2 <br />245 <br />265 <br />Screen <br />PVC <br />OD: 6.900 in. I SDR: <br />0.329 <br />6.9 <br />Saw <br />0.045 <br />211 Thickness: 0.329 <br />Cut <br />in. <br />Annular Material <br />Depth from <br />Surface <br />Fill <br />Fill Type Details <br />Filter Pack <br />Size <br />Description <br />Feet to Feet <br />0 208 <br />Bentonite <br />High Solids <br />208 1 265 <br />Other Fill <br />See description. <br />REG. 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 />.---F—T295 12 Person, Firm or Corporation <br />119 ALBERS ROAD MODESTO CA 95357 <br />Address City State Zip <br />Signed electronic signature received 07/21/2021 668622 <br />C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br />DWR Use Only <br />CSG # State Well Number I Site Code Local Well Number <br />IMMME10ma <br />Latitude Deg/Min/Sec <br />TRS: <br />APN: <br />Longitude Deg/Min/Sec <br />Form DWR 188 rev. 12/19/2017 Page 2 of 2 <br />