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03/24/98 17:15 V510 893 8205 CH2M HILLWjuuc <br /> l.ttrriKHL U1SIKll 1 lU=4Yr-rGUIJ r1r4K uc 7.0 <br /> State or California <br /> Depamnent of Water Resources -z <br /> Central DL4dd <br /> 32518 Street <br /> Sacramento,CA 95516.701T <br /> !1 <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Location: Fc I bt,.0 jtmd S, CA - i rVk ZP 4-—Iu o«{ <br /> County SEv,Zoc:,g V-""% Contract Number. 39 0017 <br /> .. <br /> Request is made pursuant to Section 13754 of the California Water Code for permission to <br /> Inspect or copy Water Well Drillers Reports which are on file in your office. <br /> 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 'CONFIDIrNTIAL" or"FOR <br /> OFFICIAL USE ONLY"and wdi be kept in a restricted file,access to which is limited to the staff <br /> of this govormentai 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 dlssaminated or published without the wrlitan <br /> permission of the owner of the well. <br /> C1�MA\L'L.(hc•1'Da%M&YLIiIJ5A) 1"Sxr,11�.�Cc�.vlv��nvlconmcn Q <br /> Contracted Aont H ylj Govammentil Agency <br /> Address „"— <br /> Address <br /> I <br /> City a�T <br /> de c-dy,Statee,7b M;1 Cods <br /> By gy�u { CJS <br /> 77 Officer -" fM <br /> Tdle Tdle <br /> �5to a51 �.�Lo 0 a <br /> TNephone Teiephone <br /> gore Date <br /> (For oepwUnMte1111(cMaeon' 1_Copts MM[ 1 <br />