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State of California <br /> Department of Water Resources ' CC T _ <br /> Central District Pry l <br /> 3251 S Street <br /> Sacramento, CA 95816-7017 <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project: 1:91?n-e <br /> Location: <br /> County: Contract;Number: <br /> 915'6 -0.7&C,/ <br /> Request is made pursuant to Section 13751 of the California Water Code for permission to inspect or cope <br /> Water Well Driller's 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 agreed that such <br /> reports, or any cope or copies made thereof, �N ill not be made available for inspection by the public but will <br /> be used solely by this governmental agency for making studies. If copies are made or taken, each copy will <br /> be stamped"CONFIDENTIAL' or "FOR OFFICE USE ONLY"and «-ill be kept in a restricted file; access <br /> to wliich is limited to the staff of this goven-jnental agency or to its contracted agents. Any copies funu'shed <br /> to contracted agents must be returned to the Depamnent of Water Resources, Central District upon completion <br /> of i ork by the contracted agent. <br /> No i'ifonnation contained in these reports can be disseminated or published without the written permission of <br /> the ox ner of the well. <br /> Grp /f t. c- <br /> Contracted Agent Governor ltal Agency <br /> /903 64 MW614 <br /> Address Address <br /> City, State, &Zip Code / City, State, Zip Code <br /> "A <br /> Bv <br /> B�GC�f <br /> Officericer <br /> f . <br /> Title Titl <br /> d 9 X08( �ta� x{50 <br /> Telephone Telephone <br /> 4t0-4f-p� ��° "a, / p Y 6 <br /> Date Date <br /> (For Departmental Information: Copies sent ) <br />