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10/12/98 MON 11:52 FAX CROUNDWS ER IM 004 <br /> , \� ="give — — <br /> State of California <br /> Department of Water Resources <br /> Central District <br /> 3251 S Street <br /> Sacramento,CA 95816-701'7 <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> sac",// �Ppiect: Grr• d . <br /> Location: <br /> County: ��/f �Va' u ' Contract t4umber. <br /> Request is made pursuant to Section X3751 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 /> inspection by the public but will be used soieiy by this governmental agency for making <br /> studies. If copies are made or taken, each copy will be stamped "CONFIDENT IAL" or "FOR <br /> OFFICIAL USE ONLY" and will be kept in a 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 Department of Water Resources, Central District upon <br /> completion of work by the contracted agent. <br /> No information contained in these reports can be disseminated or published without the written <br /> permission of he owner of the well. <br /> u OC <br /> Contracted Agent Governmental Agency <br /> Address�— Address <br /> State,&.Zip Code City,State, &Zip Cade <br /> By //1-6,e By _ k4,1,� S <br /> Officer officer <br /> 6,ee10:21P'Y4 <br /> Title,: 6f Title <br /> 3-70 -1399 , - <br /> Telephone Telephone <br /> zzzc /z 2,1q — <br /> Date Date <br /> (F-Qrrpartrtxn=1 Information: copies writ ] <br />