Laserfiche WebLink
SMITH EN, IRUNMENI HL 11= fEL 1-LUy- f�-111fb rug u� jo lv •�o 1.4u .ivy E .VL. <br /> CENTRAL DISTRICT ID:"- '-7640 OCT 04'9V0'e 8 :11 N0 .001 P.03 <br /> State of Calltamle <br /> Department of W#er Resources <br /> C WmI District . <br /> 3351 a Street <br /> Saonmento,CA 95516-7017 <br /> WELL. GRILLERS REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Pra�eat: r3v1 ���. Savo.i u 04-vi s1 <br /> Looe an: 31;�,`+ A Mot, AVtwvt K, Dj % t4 (I <br /> County; Contract Number. „ <br /> Request Is made pursuant to Section 13751 of the California Water Code for permission to <br /> Inspect or oopy Water Well Driller's Reports which are on file In your office. <br /> In accordance with the requirements of Section 13762 of the Water Code, It is atlpiAsted and <br /> aggnwd that such reports, or any copy or copies made thereof, will not be made iitveilable for <br /> Inspeotlon by #rte public but will be used solely by this governmental agency fpr making <br /> stiutles. If copies aro made or taken, each copy win be stomped "CONFIDENTtAV or "FOR <br /> OFFICIAL USE ONLY"and will be kept In a restricted file, access to which Is limited to the staff <br /> of this dovermental agency or to its contracted agents, Any copies furnished to contracted <br /> agents must be retumed to the Department of Water Resources, Central District upon <br /> completion of work by the contracted agent, <br /> No Information contained in these reports Can be disseminated or published without the written <br /> permission of the owner of the well, <br /> A-T Av oc it Us L"- <br /> tr"Od Agent Oovarnffmtal Apaney <br /> X26© "4%ti fir;M <br /> Address Addraee <br /> cA gnrj <br /> city,C %9.Zip code city,State,6 Vp Cods <br /> By � By <br /> officer Mew <br /> S _$c;w►�ist <br /> . 6-r..•rear r .r. nrw.�wrrw <br /> TWO TWO <br /> Teisphvns Telspfsonr w"�� <br /> 00te Date • <br /> (fir OarRiINIMM i11h1tgipsfli ,,,,r,r QOPiN MAt,�,,,� <br />