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—gats +bib u:bbpm f-KUM AGE NC 209 956 0700 P. 2 <br /> L� <br /> State of California <br /> Department of Water Resources <br /> Central District <br /> 3251 S Street <br /> Sacramento, CA 95816-7017 <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project :/?�/ V <br /> Location: ;k2 87/ H! (o(Q <br /> County: Contract Number:. q5g• Doi <br /> Request is made pursuant to Section 13751 of the California Water Code for permission to inspect or copy <br /> Water Well Driller's Reports which are on file in your office. <br /> In accordance with the requirerrrcnts of Section 13752 of the Water Code,it is stipulated and agreed that such <br /> reports, or any copy or copies made thereof,will not be made available for inspection by the public but will <br /> be used solely by this governmental agency for making studies. If copies are made or taken,each copy will <br /> be stamped"CONFIDENTIAL''or"FOR OFFICE USE ONLY'and will be kept in a restricted file,access <br /> to which is limited to the staff of this governmental agency or to its contracted agents_ Any copies furnished <br /> To contracted agents must be retorted to the Department of Water Resources,Central District upon completion <br /> of work by the contracted agent. <br /> No information contained in these reports can be disseminated oz published ivithout the written,permission of <br /> the 011ner of the well. <br /> &_A_4kG-e9a�UL2t7'1�t11niTY1 <br /> Contracted Agcnt �� Governmental Agency <br /> 180,3 4N--, - nom- 3d 4 W Zb-cn. <br /> Address Address <br /> �<'Darl CA '75 <br /> City,State,&Zip Code City,State,Zip Code <br /> Officer Offs <br /> �/ ,_� &*1toVr 12, 5 <br /> it]e �- Title <br /> Telephone Telephone <br /> hl&AF7--n Ila .5 T <br /> Date Date <br /> (For Dq—unayW kX-nati= copies sen <br />