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µ ., <br /> Borehole;Specifications ° ' b� `h �r` h g t; _ � Certifc �tlanStatenentt '`� ,t $ s 'rt ' sf <br /> Depth from 1,the undersigned cerdfy that this report Is complete and accurate to the best of my knaMedge and belfef <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 <br /> Signed electronic signature received 12/07/2021 290813 <br /> C-57 Licensed Water Well Contractor Date Signed G57 License Number <br /> ^§ Ftp: y 1K f Sy aF -4 tx f r3 h (4a ... <br /> . :. <br /> CSG# State Well Number Site Code Local Well Number <br /> N 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 />