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11/03/2004 09:50 1 HORIZON PAGE 02 <br /> I V- <br /> State of Califomia <br /> Department of Water Resources <br /> Central District r <br /> 32515 Street <br /> Sacramento,CA-95516-7017 <br /> WELL DRILLEWS REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project QA <br /> Location: elll � <br /> c � + f <br /> County_ Contract Number: I <br /> Request is made pursuant to Section 13751 of the California Water Code for permission to <br /> inspect or copy Water Well Driilees 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 "CONFIDENTIAL" or "FOR <br /> OFFICIAL USE ONI Y" and will be kept in a restricted file, access to which is limited to the staff <br /> of this govermental agency or to its contracted agents_ Any copies furnished to contracted <br /> agents roust be retumed 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 p4cilshed without the writtan <br /> Permission of the owner of the well. <br /> L.4 V rM+? �h.G - LGVJ2 <br /> rrComracted Agent tovernmental Asenc; <br /> v� <br /> Address Address <br /> 9 I-,AeJD IWSC 5 Z A9Z- <br /> City, Slate,&..Zip r`_deCi , State, 9.Zn r�cio <br /> Lt.cti` <br /> By officer By <br /> ffae l <br /> 'title ` <br /> T' <br /> tl� R3 r 24 1-0 20 <br /> Telephone Teleahane <br /> Data Oita • <br /> (For oepat"wgi IritorwAtion: _eopks sere y <br />