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Home My WebLink AboutImage (2)Other Observations: Borehole Specifications Depth from Surface Borehole Diameter (inches) Feet to Feet i 0 22 10 22 1 200 6 Y, Certification Statement I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief Name W.S. HEITMAN WELL DRILLING Person, Firm or Corporation 623 BUCKINGHAM PLACE CHICO CA 95973 Address City State Zip Signed electronic signature received 01/13/2021 386577 C-57 Licensed Water Well Contractor Date Signed C-57 License Number DWR Use Only CSG # I State Well Number Site Code Local Well Number Latitude Deg/Min/Sec TRS: P'I N W] Longitude Deg/Min/Sec Form DWR 188 rev. 12/19/2017 Page 2 of 2 Casings Casing Depth fro m Surface Casing Type Material Casings Specificatons Wall Thickness Outside Diameter Screen Slot Size if any Description # Feet to Feet (inches) (inches) T Type (inches) 1 0 180 Blank Low Carbon Grade: ASTM A53 0.188 6.725 Steel 2 180 200 Biank PVC N/A 0.5 4.5 Certa-Lok PVCLiner Annular Material Depth from Surface Fill Fill Type Details Filter Pack Size Description Feet to Feet 022 Bentonite Non Hydrated Bentonite 22 200 Other Fill See description. No Fill Other Observations: Borehole Specifications Depth from Surface Borehole Diameter (inches) Feet to Feet i 0 22 10 22 1 200 6 Y, Certification Statement I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief Name W.S. HEITMAN WELL DRILLING Person, Firm or Corporation 623 BUCKINGHAM PLACE CHICO CA 95973 Address City State Zip Signed electronic signature received 01/13/2021 386577 C-57 Licensed Water Well Contractor Date Signed C-57 License Number DWR Use Only CSG # I State Well Number Site Code Local Well Number Latitude Deg/Min/Sec TRS: P'I N W] Longitude Deg/Min/Sec Form DWR 188 rev. 12/19/2017 Page 2 of 2