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us/ll/au "r31 U11:33 t•:U GROUNDWATER I¢�003 <br /> State of California <br /> Department of Water Resources <br /> Central MArict <br /> 3257 S Street <br /> Sacramento,CA 95si6-7077. <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project <br /> Location: <br /> County: lam[. Contract Number. <br /> Request is made pursuant to Section 93751 of the Califomia 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 93752 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 be kept in a restricted file, mess 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. <br /> r <br /> Con cted Agent Governmental cency <br /> Po 8olr 34 ' <br /> Adcress Address <br /> City. Stat 8. <br /> . Zip Code City. State, &Zip Code / <br /> ay - �- $y l '. <br /> Officer ON er <br /> Title Title <br /> 7O `" o igf- 3 y2o <br /> Telephone Telephone <br /> Date' Date <br /> (For Depwinmltal iniormsum: awies sI 1 <br /> } <br /> { <br /> r <br />