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state of Caliro,, v <br /> Department of Water Resources <br /> Central District 1 <br /> 3251 S Street <br /> Sacramento, CA•95316-7017 <br /> WELL DRILLERI REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> i <br /> Location: <br /> County, pLL LLIh Contract Number. <br /> Request is made pursuant to Section 13751 of the Califomia Water Code for permission to <br /> mspect,or,Copy_Water.Well Drilleej Reports which are an file ih. yourIn accordance with the requirements of Section 13752 of the Water Code, It Is stIlDulated and <br /> agreed that such reports, or any copy or copies made thereof, will not be made available for f <br /> Inspection by the public but will be used solely by this governmental agency for making j <br /> studies, If Copies are made or taken, each copy will be stamped "CONFIDENTIAL" or "FOR <br /> Of FICIAL USE ONLY"'8nd'will•be kept in a restricted file, access to which is limited to the staff i <br /> of this govermental agcncy or to its contracted agents. Any copies fur'r5iShed to contracted <br /> SG[ents must, hft f►t,1,lirnf,4 tj�L the Dow-MOM .l. VA!wf: Rescearcew, can.ttir,1l Dl�+,�c; Lpor1 <br /> COr11plation &wnrk by the rnntraMarl agont. i <br /> 1��.•lrlirs: Ctrl l'1 1"lr"1" itlt*ii�'3 ir'r tiSa�$rdNt'rj`id +.:h!r'Inr u r:i llril'1'alL''!t u�'frtJiMTdcr wlCi'Tour M0 wnrfan <br /> permission of the owner of the weil,r <br /> �ti Jaa.�v,yt Covt�.� <br /> 71it1 eco- oyr y-o 1yt L• �yi✓� eh <br /> Contracted Agent Covernrrten I Agency <br /> 7d3� Aarn 5 /o0 445 •�/. oohaq�lh ��• <br /> FS x 3g8 <br /> Address Address <br /> 6W46-tlt j 64 4�6�� Seo �t� (� ;ISZ0-03 <br /> -^ - .Citji;`8tate,r&-,Zip CadeCity, State, Zip Code <br /> By <br /> Gh,C'/5 Omca By <br /> F N/��5 .9KY omcer ghY� <br /> Title j Title <br /> {sol Itsss-7G 7$ <br /> Telephone Telephone <br /> l/ZIA. A/ <br /> Date ;; <br /> Date <br /> 4 <br /> (For Departmental Informwon, _ eaplw sent <br /> » I <br />