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State of California <br /> Department of Water Resources <br /> Central District <br /> 3251 S Street <br /> Sacramento, CA 95816-7017 <br /> NWELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project e <br /> Location: C <br /> County: S4#u Jjag fid, f% Contract Number. <br /> Request is made pursuant to Section 13751 of the California Water Code for permission to inspect or copy <br /> Water Well Driller's Reports Ahich are on file in?•our office. <br /> In accordance with the rap*czncnts of Section 13752 of the Water Code,it is stipulated and agreed that such <br /> reports;or any copy or copies made thereof,will not be made available for inspection by the public but hill <br /> be used solely by this governmental agency for making studies. If copies are made or taken,each copy will <br /> be rtmigied"CONFIDENTIAL."or"FOR OFFICE USE ONLY"and will be kept in a restricted tale,access <br /> to%%Nch is limited to the staff of this governmental agency or to its contracted agents. Any copies furnished <br /> to ommctod ageits riaist be retamed to the Depatment of Water Resources,Central District upon completion <br /> of Wrork by the contracted agent. <br /> No information contained in these reports can be disseminated or published without the%% itte n permission of <br /> the owner of the well. <br /> Aj o ncto &0 &,t.•rel►W 0*d , �/fit• l#uw 5�r r.&" f.,c eertaj 1 )*R LTij AA <br /> Contracted Agent _T Goversunental AApa <br /> Addmss Address <br /> Srjaiwj . r1A JTe'SKTen , lc9 o a <br /> city,State,et zip Code State,Zip Code <br /> av C>z lla,/- <br /> Officer Officer <br /> . S. <br /> Tine Ti <br /> Y-h3 —10 (2 -W�- 0 <br /> TTeleephone Telephasu q9 <br /> Date Date <br /> (Fa DCP-UD-W Wb—"Q--Com ant } <br />