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Saie:cif California <br /> Department of'Water`Resources <br /> i✓entral District; <br /> 3251 S Street . <br /> Sacramento,CA 958,16 7017 <br /> WELL D.RILLMI S REPiOM S <br /> XNSP. CTWN:REQUEST :4I�?D AGRIEt ENT <br /> Location: ` Of, <br /> County: ✓-� �A q [i/l Coniract Number, <br /> Request is made pursuant.to Seet�an: 31�t of the Cal, <br /> iforn4r.-eateode for pen1.nssitin to inspect or copy, <br /> Wker well,DriIlees.. ports j'hick are on file inti}'our once: <br /> ln'accgrdance i� tli the�requuei `eflts of Sectlon,;13 32-6f the eater Code;,i't is stip'glated an'd agreed`thaY siz'cli <br /> reports,.or-oozy copy;.or eopies:made thereof,«gill not`be niade available for inspection by;the public but will <br /> lie;used solely b'thus governirientai ii errcy fo inakin :studies. If.copies'are mad' `taken;.each::copy Neill <br /> b-e,stampecl"CONFIDENTIAL''or TOR OFFI�,EeUSE ONLY'anti«gill be keptin a restricted file_,access <br /> to Which Ji limited to the staff of.this governmental-agency or:to its contras"ted agents Any copies>futYiished <br /> 'to contracted age-nt-s.n,tust be rete ned.to;the T3eparEment:ofNVdter,Resources, Central District>t�pon completion: <br /> of.uorlc by the;contractec3 agent, <br /> 1\To itifgli a ton sgntauieii in rhp e eports pan lie dissenlmaterl<or published�ithout the�eiitten,periruss of kof< <br /> riteoWner of the well, <br /> Contiaefed Agerita�eiiunental Agency <br /> r <br /> Address Address': <br /> - �� ( .503 <br /> C�h,,State 8t, ip Code City, Sfafe..Zip Code <br /> Pv _Cv - C By `��:_t'i'►�-Q �,/l��'l7_-__� <br /> -Qf 1C T: Off 710ETa <br /> i .- <br /> � ZC <br /> Title <br /> Tiilc <br /> 'Telephone Telephone <br /> Date Date. <br /> (for DepartntentalInfi+isn�tiSti:. Cop'ies3eiitt ); <br /> r <br />