Laserfiche WebLink
I 2 APR 01 '95 11:47AM FUGRO WEST ROSEVILLE <br /> SEete Of Catlfomla <br /> Depatmerd of Watrr Rtmroes <br /> Central Dwks <br /> 32516 Sttiet <br /> Sacramento,CA 05816.7017 <br /> WELL.DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project: i F- _21 r-T J SCL 0 r(Z S maJ i�kll J-71 <br /> _ <br /> ;l h <br /> Location: I Z S 4 ^)ot4u (-)I L.Sa^) a- <br /> i County. S tAr^J b6-k Contract Number <br /> Request is made pursuant to Section 13751 of the California Water Code for permission to <br /> inspect or copy Water Well Driltees Reports which are an file in your office, 1I <br /> In accordance with the requirements of Section 13752 of the Water;Code,'�it is stipulated and <br /> agreed that such repons, or any copy or copies made thereof, will riot be Imade tellable for <br /> inspection by the public but will be used Sol" by this gavemmental agency for making <br /> studies. 1f copies are made or taken, each copy will be stamped "CONFIDENTIAL' or"FOR <br /> OFFICIAL USE ONLY"and will be Kept in a restricted fila, access to Which is"'limited to the staff <br /> of this govermental agency or to its contracted agonm Any copiss 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 I <br /> permission of the owner of the well. <br /> Contracted Agem Gorrernmir l Ag'enry <br /> ! <br /> OTC-) �er`� `i 14J. �lTt Jco 304 i✓ 0e eir e <br /> Address Address <br /> ! <br /> Sb Wit. r Cit WW - <br /> City state; &.Ziip Cods .CIS)►.State. 7JP,(Code <br /> lay _AnLTBy a Lt -_a <br /> .. <br /> oRtser of er <br /> Title lifts <br /> Telephone Teleppons <br /> 1 7 44 h <br /> Date Oats !I <br /> (Far 0vpwtnMW kd�rerpetr9 erepre6 wwt <br /> !t <br />