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y-by i�lyb 11 :00AM FROM AGE NC 209 9SS 0700 p_ 2 <br /> 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 <br /> �REQUEST AND AGREEMENT <br /> Project; t(.l"—"01 1L Cpt t-A own <br /> Location: 1,I)SX) rXXj-t6 pyo 7n <br /> County_ Sjw Contract Number- 4-77— q(` <br /> l�rr} <br /> Request is made pursuant to Section 13751 of the California Water Code for pemrission to inspect or copy <br /> Water Well Driller's Reports which are on file in)our office. <br /> In accordance with the requiremars of Section 13752 of the Water Code,it is stipvlated and agreed that 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 will be kept in a restricted file,access <br /> to which is limited to the staff of this governmental agency or to its contracted agents. Any copies famished <br /> to contracted agents must be returned to the Depanmert of Water Resources,Central District upon completion <br /> of work by the contracted agent. <br /> No information contained in these reports can be disseminated or published without the written permission of <br /> the owner of the well. j <br /> `x+n J�v>r�1 �i7an <br /> ,Vav�4�F tt� ��.�,�, Gl?l/7 rCYI>nrnATUY (levet 1�'-� <br /> Contracted Agent Governmental Agency <br /> Address Address <br /> s OA 95Z07 5�0�� C� 9po ) <br /> City,State,,k Zip Code �/� City,Stale, <br /> Zip Code <br /> By 14t � twm k r /�� By 5 m �zz&,2 <br /> Officer ftficer <br /> Title Title <br /> V69' 3 YY� <br /> Telephone Telephone <br /> Vj l99b 91qlg& <br /> Date Date <br /> (Tv nm.rtnvW Lffamn6ac�Coy�o arnt ) <br />