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( ;l 1141 rttyt U1.�I K14.I �lc d�lU zrl5 CH2h[ HILL I@O02 <br /> 1Lf—f4UU MHK U-l_ 15;bb Nu.U15 p•02 <br /> State of CalKamw <br /> DOParrmentaf WaterResounw <br /> C91111111 DkWct `4S <br /> 3251 a sweet <br /> Sacrarrl rte,CA 95816.7017 <br /> WELL DRILLER'S 1Z1wpORTS <br /> 1NSPECMN REQUEST AND AGREEMENT <br /> p!cjact; <br /> iSc <br /> UVrti �' f'i I b�,. '!'t'pF.'t5, Sjncrr.Fah ch <br /> CortntSr. SGY.S© ,j L„ Contract Number: 3 G{ OC)O <br /> Request is made pursuant to Section 13759 of the California Water Cotte for permisslon td <br /> Inspect or copy Water Well Drillees Reports Which are on file In your office. <br /> In accordance with the requirements of Section 13752 of tha Water C*ds, <br /> it Sfiputatad and <br /> B9red filet such reports. or tarty Dopy or copies mWe !hereof, will not be merle amAabie for <br /> lnspettion by the prbHc but 4bill be used solely by this govemmentel agency for making <br /> modes. If Copies are made or taken, each copy will be stamped "CONFIDENTIAV or"FOR <br /> OFFICIAL.USE ONLY"and welt be kept in 8 restricted Me,sOM33 to WKct is limited to the staff <br /> Of this govermentat agency or to Its contracted agents. Any topica furnished to contt�cxed <br /> agents roust be returned to the Department of Water ny Resources, Genua) District upon <br /> comp1e60n of work by the cgntr8cted agent. <br /> No information contained in these reports Can be disseminated or pubiished without the written <br /> permission of the owner of the well. <br /> .��1��YY1 (�A <br /> srO acteQA prd �'~�"` rUlyirohma {AQ <br /> � ` L <br /> khQ Ge[v#MMWltat Agency <br /> 1 1l 171t�uu `1 G adL� 3o 6i €.. wecar AVP A �c <br /> Address Address <br /> City ds City,state.a zip Cods <br /> orn <br /> 8y By <br /> - <br /> . eer �� .• . <br /> - �('Pti'�.YVtC�h0.�l'" cm�"crlS0.Q ��8d��i4.QexaY <br /> rue ruo <br /> Lfad, yi_oo ;YAa <br /> 7elept►one ra*nota <br /> • DBte t�tb <br /> [For osppUnera inf m an: _ =ph=tem t <br />