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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 /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project- ;} N e., <br /> Location: %11LAili- :e e.+ C,f' C;Z 1. Fe�;�, &f �- <br /> County-. _�r_n J O Contract Number: <br /> Request is made pursuant to Section 131751 of the California Water'Code for permission to inspect or copy <br /> Water RTell Driller's Reports which:are on file in your office. <br /> In accordance«nth the requirements of Section 131752 of the Water Code, it is stipulated and agreed tliat such <br /> reports, or any copy or copies made thereof «will not be made available for inspection by the public but will <br /> be used solely by this governmental agency for making studies. If copies are made or taken, each copy\will <br /> be stamped "CONFIDENTIAL`'or `'FOR OFFICE USE ONLY"and "III be kept in a restricted file. access <br /> to Nvhich is limited to the staff of this governmental agency or to its contracted agents. Any copies furnished <br /> to contracted agents must be returned to the Department of Water Resources, Central District upon completion <br /> of work by the contracted agent. <br /> No infom-iation contained in these reports can be disseminated or published N�ithout the written pennission of <br /> the oNv,ner of the well. <br /> S ('¢jsitx ( C#yA4V _E 1 <br /> Contracted Agent �• " Governmental Agency <br /> Address Address <br /> Cit,, State, &Zip Codei�ty, State, Zip Code <br /> Officer - Officer <br /> Title Title <br /> 7 It 101 %09 - 3 <br /> Telephone Telephone <br /> Date Date <br /> (For DeparLmcrnal Zttfertriatioti: Copus senE ) <br />