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9-09-1996 11 .30AM FROM AGE NC 209 9S6 0700 R• 3 <br /> State of California <br /> Department of Water Resources <br /> Central District <br /> 3251 S Street <br /> Sacramento, CA 95816-7017 <br /> WELL DRILLER'S REPORT'S <br /> INSPECTION REQUEST AND AGREVNIENT <br /> Project• a R 1 r lW r 7�Y1 <br /> Location_ AmPUFt✓ [dC„ ? <br /> County: � � ►� Contract Aura er:_:2%1 RZ 1T447- <br /> Request is made pursuant to Section 13751 of the California Water Code for permission to inspect or copy <br /> Water Well DrilIer's Reports which are on file in your office. <br /> In accordance vith the rcquireme.*;t of Section 13752 of the Water Code,it is stipulated and agreed that such <br /> reports, or any copy or copies made thereof,-Mll not be made available for inspection by the public but«>ill <br /> be used solely by this governmental agency for making studies. If copies are made or taken,each copy Hill <br /> be stamped"CONI=IDENTIAL*l or"FOR OFFICE USE ONLY"and«gill be kept in a restricted file,access <br /> to which is limited to the staffof this governmental agency or to its contracted agents. Any copies furnished <br /> to contracted agents must be retumad to the Department of Water Resources, Central District upon completion <br /> of work by the contracted agent. <br /> No information contained in these reports can be disseminated or published without the written permission of <br /> the owner of the well. <br /> . 16_NJI(�0 _ �.Nr�i12 �ttlrtr� �Vi�f <br /> Contracted Agent 1 Governmental Agency <br /> / Zee /yrs r ?�y. .ife�,4 Ei. 4J b "2 V Prdw <br /> Address Address <br /> City; State,&Zip Code City,State,Zip Code <br /> Officer Officer <br /> a�tr, <br /> ��� �{ Title <br /> Telephone Telephone <br /> 1?910 <br /> Date Date <br /> (For Depamneaw tnfcvrs tU= Copist 3cm <br /> M!D <br /> �s <br /> �«` L#W - W <br />