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05/30/2000 09:37 2094677 'I AGE STOCKTON PAGE 03/04 <br /> State of California <br /> Department of lVater Resources <br /> Cearal District <br /> 3251 S Street <br /> Sacramento, CA 95816-7017 <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project• �'� f�� <br /> Location: WJ u3` S <br /> Counts: r ' Contrau Number: <br /> Request is made pursuant to Section 13751 of:=,: California 1Vater Code for permission io inspect or cope <br /> �Vzltr Well Drillers Reporu w)• ch are on fait iia tour office. <br /> In accordance vith the requirement of Section l_i752 of the Wilier Code; it is sllpiAated acid agreed that such <br /> reports; or ani,copy= or copies made thereof, %611 not be made m7milable for in!:pect.ion by the public but NAV <br /> be used solely by tla s govrmniental agency for making studies, if copies are made or taken, each copy %ill <br /> be rL23nped "CONFIDENTLkL" or "FOR OFFICE USE ONIY"and Mill be kept in a restricted file, access <br /> tow1lich is]united to the staffcf this governnter-1l agency cr to its contracted agmis. Any copies furnished <br /> to contracted agents must be resumed to the Dep�_rznent of 1�7ater Resow-ces. Central District upon completion <br /> of wonk bY the contracted agent. <br /> No infonn tion contained in rhes: reports can be Lssenii.nattd or published t%ithout the wriven pcmzissio:i of <br /> the owner of the well_ <br /> Lu.,1-0 <br /> P a I <br /> Contracted Agem Gm-cmintntfl ASency <br /> w i U (4)a <br /> Address Address <br /> Cir\•. State, &Zp Code Cit.', Stale;Zip Cede <br /> 2V Ai'11111hal-) By <br /> OiT:rer Officer <br /> Title <br /> r <br /> Telep-,one Telephone <br /> D ' <br /> D jF <br /> ENVIRONME&AL HEALTH DIVISION <br /> 304 E. Weber Ave. Third Floor <br /> (Fw Dtpatmttrisl Worr�tiors_ Cc,9t�scnP O. Box 388, Stockton CA 95201-0388 <br /> Approved <br /> Conditions <br /> dateNL_ <br /> 06 _by. <br />