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06/03/2004 12:14 20946711'" AGE STOCKTON PACE 03/0 <br /> r <br /> State of California <br /> Depairtmca of Water Resources <br /> Central District <br /> 3251 5 Street <br /> Sacramento, C,A.95816-7017 <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project- <br /> Location: <br /> rojectLocation: — <br /> county,:max Contract Number <br /> Request is made pursuant to Section 13751 of the California Nater Code far peen mission to inspect or copy <br /> Water Well Driller's 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 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"CONFIDENTIAP or"FOR OFFICE USE ONLY"and`,%ill be kept in a restricted h1e, access <br /> to'wN,-'t is hn-dted to the staff of this governmental agency or to its contracted agents_ Any copies furnished <br /> to contracted agents must be returned to the Department of'Water Resources, Central District upon completion <br /> of work by the contracted agent_ <br /> No inforrnation contained in these reports can be disseminated or published without the written perp-dssion of <br /> the owner of the well. <br /> Contracted Agent G ez�#aZ Az ency <br /> gj5a op,— 30 W ehel- ,31c! Poo- <br /> 4 <br /> Address Address <br /> S+acVzx,a CcL i;" cs- Com- gsa� y <br /> City, State,&Zip Code City,Sfate,Zip Code <br /> lVlfl' CI BY- <br /> an_ <br /> afficer Officer <br /> 6e2V <br /> Title � �tle �� <br /> Telephone Telephone <br /> Date Date <br /> (7w DcPWuromw r+ 60n, -co0w=,k- <br /> l <br />