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State of California <br /> C)epartment of Water Resources <br /> Central District <br /> 32513 Street <br /> Sacramento,CA 95818-7017 <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project: <br /> Location: <br /> 91�s UfGI w,. �r �: iL d t Va <br /> County: .�C Contfaet,Numbes•: <br /> Request is made pursuant to Section 13751 of the, California Water Code for permission to <br /> Inspect or copy Water Weil Drillers Reports which are on file in your office. <br /> t 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 solely by this governmental agency for making <br /> studies. If copies are made or taken, each copy will be.stamped "CONFIDENTIAL" or "FOR <br /> OFFICIAL USE ONLY" and will bb 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 the owner of the well. SAN.IOAQU119PUBLIC HEnTH <br /> ENVIRONMENTAL HEALTH 01TVAON <br /> 304 E WEBER AVE 3"F4 <br /> STOCKTON CA 9M <br /> Contracted Ag nt Governmental Agency <br /> Address Address <br /> C-A _ �t`f(�O -_ . <br /> city, state, &.Zip Code Cfty, State, $Zip Cade <br /> By V� (-Z i Irl� , . 6 , SY <br /> offer Officer <br /> 5 <br /> e me a[a.- a <br /> I TitleT <br /> �39 <br /> o ( cq) Ll6'S6 33 1 <br /> Telephone Telephone <br /> b 12 <br /> Q>ate DON <br /> (For osparmiontal lnronnown: -copies sent <br /> 300d Lb6966801:9:XUJ dno8o 2131UM 8HOM U3'10:Qi 9T:60 Wd 00, ST/zT 880.ON 3-1I3 <br />