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:ENTR4L DISTRICT ID 22?'i60(i NRR 2"971 11 :37 1`4C .000 P -02 <br /> state of California <br /> Department of Water Resources <br /> Central Destrid <br /> 3251 S Street <br /> Saaramartto,CA 95816-7017 <br /> WELL DRILLERS REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project: �IkCo /=+'i/i�"' 1114. L/6/e5' _ 2f�`U ,Em: fLae{'•r,�t 64Aell Skr�@ y <br /> Location- s. Cl,�/—�/ LJav' S>dcEro r� � 9SzaG <br /> County: Contract Number: <br /> Request is made pursuant to Section 13751 of the California Water Code for permission to <br /> inspect or copy Water Well Drillers Reports which are on file in your office. <br /> In accordance with the requirements of Section 13752 of the Water Code, it is stipulated and <br /> agreed that such reports, or any copy or copies made thereof, will not be made available for <br /> inspection by the public but will be used solely by this governmental agency for making <br /> studies. If copies are trade or taken, each copy wiil be stomped "CONFIDENTIAL,' 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 govermental agency or to its contracted agents. Any copies fumished to contracted <br /> agents must be returned to the Department of Water Rescurcce, C::atr-_t CistriU upon <br /> completion of work by trie Contracted agent. <br /> No information contained in these reports can be disseminated or published vdthout the written <br /> paar'missi/o'n of the owner of the well. / <br /> ..6-7 `O/QO/Q r 0,1 r�Rf f/.L r:.,! :Joh Tf4.-ru—�i �/e'4�i G J pl✓. j <br /> Contractee Agem Caovernmental Agency <br /> 3939 C"_'2 i2ao _C u:�v 22-0 oo y C', Wv A-a Fl vx 3� r rl(6 r <br /> rr Addreea' Addfeas <br /> lOmeeV, Park . 4fs3 /.S��YZ ,1 rn�.k ro/, GA 'If Zn2 <br /> City, st te, &VP cCaoe C ty, state, &Zip Coal <br /> By <br /> ,Officer OMCer <br /> Title TA a <br /> / Te*ncne Triepnuna <br /> 2�3�do <br /> Date Deta " <br /> (Far Damnmantal iniymecpn: �wPerr tr■nt t <br /> Zo "d UOL4eJtod..t03 lI d0I = 10 00-Li-qaJ <br />