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Oct 17 01 04: 24p H­izon Env. Inc 81F 938 2172 p. 2 <br /> State of California <br /> Department of Water Resources <br /> Central District <br /> 3251 5 Street <br /> Sacramento, CA-95816-7017 <br /> WELL DRILLERS REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> �j <br /> Project: 0t ,,C _ 54P... <br /> Location. �"' � G1�5' i i .Q �U-0 Kt <F <br /> County: B <br /> ty' Co ntract Number <br /> Request is made pursuant to Section 13751 of the California Water Code for permission to <br /> inspect or copy Water Well Drillers Reports which are on fie 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 ONLY"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 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 /> Contracted Agent Governmental Agency <br /> Address Address <br /> City, ,t3:e, S-2?p r,:�e City, $tat A 7i- Coda <br /> Officer Officer(/ ��,,/ <br /> t f�'r``Y/' l t`�I �l( _/'t��/3 <br /> Tie U Ti <br /> L Z <br /> Telephone Telephone <br /> II S I � Vr k Zoa I <br /> • <br /> Date Date <br /> {For 17epartmental Infonnatlon. . Copies mt_ } <br />