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308 330 1 SHALE <br />Other Observations: <br />Casings <br />Borehole 5 pecMeations <br />Certification Statement <br />Depth from <br />asing <br />Depth from Surface <br />Casing Type <br />Material <br />Casings 5peciiicatons <br />Wall <br />Thickness <br />outside <br />Diameter <br />Screen <br />slot Size <br />if any <br />Description <br /># <br />Feet to <br />Feet <br />Address City <br />State <br />(inches) <br />(inches) <br />Type <br />(inches) <br />C-57 Licensed Water Well Contractor Date ffigned <br />1 <br />0 <br />300 <br />Blank <br />PVC <br />OD: 6.625 in. I SDR: <br />0.316 <br />6.625 <br />FTNI <br />I I _w] <br />Latitude Deg/Min/Sec Longitude <br />Deg/Min/Sec <br />211 Thickness: 0.316 <br />TRS: <br />APN: <br />In. <br />2 <br />300 <br />320 <br />Screen <br />PVC <br />OD: 6.625 in. I SDR: <br />0.316 <br />6.625 <br />Saw <br />0.045 <br />211 Thickness: 0.316 <br />Cut <br />in. <br />AnnularAiliterisl <br />Depth from <br />Surface <br />Fill <br />Fill Type Details <br />Fitter Pack <br />Size <br />Description <br />Feet to Feet <br />0 <br />100 <br />Bentonite <br />High Solids <br />100 <br />1 320 <br />Other Fill <br />See description. <br />GRIT SAND <br />Other Observations: <br />Borehole 5 pecMeations <br />Certification Statement <br />Depth from <br />I, the undersigned, certify that this report Is complete and accurate to the best of my knowledge and belief <br />Surface <br />Feet to Feet <br />Borehole Diameter (Inches) <br />Name MASELLIS DRILLING INC <br />Person, Firm or Corporation <br />0 330 <br />11 <br />119 ALBERS ROAD MODESTO <br />CA 95357 <br />Address City <br />State <br />Signed electronic signature received 10/31/2019 <br />668622 <br />C-57 Licensed Water Well Contractor Date ffigned <br />-57 License Number <br />Attachments <br />DIM Use Only <br />Image_00417.pdf - Permit <br />CSG # State Well Number Site Code <br />Local Well Number <br />19319 Oakwood Rd Stockton.pdf - Location Map <br />FTNI <br />I I _w] <br />Latitude Deg/Min/Sec Longitude <br />Deg/Min/Sec <br />TRS: <br />APN: <br />Form DWR 188 rev. 12/19/2017 Page 2 of .2_ <br />