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05/31/01 THU 15:02 FAX 1 016 861 0400 SECOR-SACRAMENTO 0 003 <br /> LLf4I kH1. Ulb in 1L. i <br /> la <br /> Stent Of Water <br /> Department of Water Resources <br /> Central DW4 cl <br /> 3251 8 Street <br /> Sacramento.CA-105818-7017 <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> ProJoct �.DYV1Clt°.� � -�b <br /> L�S��L.t/t..vyC-4 Ul bli�� GIS <br /> Location: , <br /> County Contract Number.b�M_—AA2�� <br /> Request is made pursuant to Section 13751 of the California Water Code for permission to <br /> Inspect or copy 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 <br /> agreed that such reports, or any copy or copies made thereof, will not be made available for <br /> inspectlon by the public but will be used solely by this aovemmental agency for making <br /> studies. If copies are made or Laken, each copy will be stamped "CONFIDENTIAL" or "FOR <br /> OFFICIAL USE ONLY" and will be kept in s restricted file, access to which is limited to the staff <br /> of this govermental agency or to its contracted agents. Any copies furnished to contracted <br /> agents must be returned to the Depanmeni of Walef Resaurees, Central District upon <br /> completion of work by the contracted agent. <br /> No information contained in these reports can be disseminsted or published without the written <br /> permission of the owner of the well. <br /> Contracted Agent Governmental Agency <br /> Address Address <br /> Q (�rnd r� I<I4 �l0"1b sk-b� t <br /> Llty, State. 8? Godo _ ,City. State. 8 Coat <br /> By By 74 <br /> Olieer Officer <br /> Atll <br /> Title Talc <br /> �q � Q In <br /> rro�e <br /> Telephone <br /> 531 (o - i — 0/ <br /> Dela Dac° <br /> (For the 4dam`0°"• <br />