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GROUNDWATER IgUU2 <br /> 10/12/98 SiQN 1.1:51 FAS . <br /> State of California <br /> pepactment of Water Resources <br /> Central District <br /> 3251 S Street <br /> Sacramento,CA 95816-7017 <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project: <br /> Locaticn: �I <br /> I County: �Cc/� �16c► : Contract Number. <br /> Request is made pursuant to Section 13751 of the California Water Code for permission to <br /> inspect or copy Water Weil Driiier's Reports which are on fire in your office. <br /> to accordance with the requirements of Section 131-52 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 soiely by this governmental agency for making <br /> studies. If copies are made or taken, each copy will be stamped "CONFIDENT IAL" or "FOR <br /> E OFFICIAL USE ONLY" and will be kept in a restricted file, access to which is limited to the staff <br /> o ;his govermental agency or to its contracted agents. Any copies furnished to contracted <br /> agents must be returned to the Department of Water Resources, Central District upon <br /> completion of worst by the contracted agenL <br /> No information contained in these reports can be disseminated or published without the written <br /> permission of the owner of the well- <br /> Lk or <br /> ell_Lkor G� SJ��o - P145 16�, <br /> Contracted Agent Governmental Agency <br /> 004�17 old <br /> Address Address <br /> zfX <br /> State, &.Zip Code City, State, &Zip Cpode <br /> By ;;e-�iC,e✓ By T\,n `2 <br /> Officer (Officer <br /> Title Title <br /> .3� �d Yt�z. <br /> TTelephcne Telephone <br /> Date date <br /> (For oepartt-nen al frforrrallon: coQ{es srnl } <br />