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04/01/2003 14:41 2094683433 FIFTH FLOOR PAGE 01 <br /> ' .. .. PA(a� 021 02 <br /> 04101/2003 le;27. 20946711 AGE STOCKTOtJ r..,� <br /> State of California <br /> Department of Water P esOUree5 <br /> Central District <br /> 3251 S Street <br /> Sacramento,CA 95816-7017 <br /> r <br /> WELL 3DRILLER.'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project• � <br /> "-Oon 3 AN <br /> County. Contact Number: <br /> RetlucA is made pur=r nt to Section 13751 of the Uifornia Water Code far permissic •to inspect or copy <br /> "Dater Well.Dtx7ler's Reports wbkh are on file in yaut Office. <br /> In accorda=V*hthe requivmcnts of Section 13752 of the Water Code,it is stWated and agreed that such, <br /> repom,or any copy or copies made thereof,will not be trade available for inspecdon by the public but VAIl <br /> be used solely by tins governmerftal agency for making studies. If copies axe made or taken,each copy uryll <br /> be.stamped"CON)+jDEq TA V'at"FCR OFFICE USE ONLY"and will be kept in a restricmd Blehsss <br /> m, <br /> to which is limited to the stag of this goven emd agency or to its coat ucted agents. Any Cap <br /> ius ed <br /> to coutmc:ted agents must be xetumedto the Depa runt of water Resou%ccs,Cet bbl District upoa eainpletim <br /> of work by the contracted agent. <br /> No iafommfica contained in tbese morts can be dissermnated or publisW without the writ=permission of <br /> the mvner of t$e well. <br /> 1•I�I/Q'Fl 11J11 � �.�(' _ .Sc..Y.•�ao,�.u.�.�°*�,�.�.�- <br /> Comuseted Agent G m=enw Agency <br /> 3 14 'f7 11�6' 0-- Alm- 3 ref PV r <br /> Address Address <br /> ,States&Zip Code City,State,Zip Coda <br /> bac <br /> &Y— ` 'title Title <br /> roFO467-'/00! 40 <br /> Telephone Telephone <br /> '41 1 163 <br /> Data Date <br />