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Aug 28 01 12: 51p He 4 zon Env. Inc 91 F-39 2172 p. 2 State of California Department of Water Resources Central District 3251 S Street Sacramento.CA-WI6-7017 WELL DRILLER'S REPORTS INSPECTION REQUEST AND AGREEMENT Project: Rrma r Bxaco-�.t SW�Ovt t 0& 114 f Location: 5`o c•4-loyk , (fA County: S kt CA jaL&•H - Contract Number. 7-3 Request is made pursuant to Section 13751 of the Califomia Water Code for permission to inspect or copy Water Well Driller's Reports which are on file in your office. In accordance with the requirements of Section 13752 of the Water Code, it is stipulated and agreed that such reports, or any copy or copies made thereof, will not be made available for inspection by the public but will be used solely by this governmental agency for making studies. If copies are made or taken, each copy will be stamped "CONFIDENTIAL" or "FOR OFFICIAL USE ONLY" and will be kept in a restricted file, access to which is limited to the staff of this govermental agency or to its contracted agents. Any copies furnished to contracted agents must be returned to the Department of Water Resources, Central District upon completion of work by the contracted agent. No information contained in these reports can be disseminated or published without the written permission of the owner of the weli. ttprliroK G,�V1r0KVKe Ci,� �vtG �iwJMaiAOJl8rµvr� Contracted Agent I Governmental Agency rod-4M low s T- 304 fas-' Wo btw Address Address ( DoVxkthik . C.4 q5-t67— S.`�a�� . C1k '557—Q( - 0M9 City, e f-Tde Ci , Stat Zr^ ta.e, .Zip By eYA S rwt;f�t BY Officer Officer fro Ma,Ka�er . RG No. ca3o� � CS6 / t /e S 9 Title Title ' MN ) k3q— 4(Tt (OT `t� 3�(5 - Telephone Teiephone 46 t Date a Date (For Departmental Infonmatlon: copies sent 1 lr""