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State of Califortua <br /> Department of Water Resources <br /> Central District <br /> 3251 S Street <br /> Sacramento; CA 95S I6-7017 <br /> i <br /> WELL DRILLER'S REPORTS � <br /> INSPECTION REQUEST ANDAGREEMENT <br /> Projeet = 3= (,, „n <br /> i <br /> Location: C. ' C'" ° <br /> County: ,-4R t� Contract Number`,: <br /> , �I <br /> Request is made pursuant to Section 13751 of the CaliforniaWat Ir Code for.permission to inspect or copy <br /> Water Well DrillersReports vxhich are-on file in your office. <br /> i In accordance,�n'ith'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. I,f1copies are made or taken. each copy will <br /> be stamped"`CONFIDENTIAL"or"FOR OFFICE USE ONLY I 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 returned to the Department of Water Resources,Central District upon completion _ <br /> of work by the.contracted agent: <br /> No infonuation.contained irr these reports canbe.disseminated or published Nvithout the written permission'of � <br /> the owner of tine well. <br /> 5A tj J-v^G2vtN CCIUi DTIf <br /> A 'i L,�,.,,d `be t- 01 t;;sffiJY t����1rs�` ' Lrl�v1�,,►zc�/� JhL lt�tZTi� ��% <br /> Contracted Agent !Governmental Agency <br /> `���C�c�� �`�.�-� 3rs�-(L.I •in3��2'�4V�j- C <br /> Address Address <br /> City, State,&Zip:Code 'City,State,Zip Code { <br /> Bva <br /> C. <, <br /> Officer J Officer <br /> u Title Title <br /> A vri �D 3 �- <br /> Telephone �� Telephones ' <br /> 20 <br /> DAte <br /> 4 <br /> i <br /> (For Departmental Information: Copies sent <br /> N , <br /> k <br />