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Borehole Specifications f� �L Certificaj. tion 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 HENNINGS BROS DRILLING CO INC <br /> Feet to Feet <br /> 0 250 12 Person,Firm or Corporation <br /> 250 320 8 1930 LADD RD MODESTO CA 95356 <br /> Address City State <br /> Signed electronic signature received 11/29/2023 290813 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> DHVRUse Only .s : <br /> CSG# State Well Number Site Code Local Well Number <br /> NIF] 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 />