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State ofCauK F -5 PM 3: 02 <br /> Department of Water Resources <br /> Central District <br /> 3251 S Street <br /> Sacramento, CA.95816-7017 <br /> WELL. DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Piooa ROG G•7 ¢usD^ <br /> Location: +c1l R an D <br /> County: SA+v Jenov;n Contract Number:— <br /> — <br /> Request is made pursuattt to Sectico 13751 of the California Water Cale for permission to inspect or copy <br /> Water Well Driller's Reports which are on We in your office. <br /> In accordance with the Mpiren=o 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 madc available for inspection by the public but will <br /> be used solely by this governruentat agents'for making studkzs, 1f copies ate made or taken,each copy will <br /> be stamped"'CONFIDENTIAL"or"FOR OFFICE USE ONLY"and will be kept is a restricted file, access <br /> to which is hunted to the staff ofthis governmental agency or to its contracted agents. Any copies fiunished <br /> to euatrac2al agents must be resumed to the Departmarg of Water Resources,Centras District upon completion <br /> of work by the contracted agent, <br /> No information contained in these reports canbe disseaninated or published withoat the written permission of <br /> the mvner ofthe well_ <br /> Coatracted Agent C"VenumeAal Agency <br /> ah L A 32 C <br /> Address Addree;s <br /> city,-61e,&zip <br /> rCode <br /> � GtiQtY,Slate,Zip Code <br /> py <br /> Officer U Officer <br /> Q©41a Gen1aC91 I1 _ `first <br /> a <br /> � t 7411e itlo// <br /> (7,0 ) `"15L (AIR, 0T5a <br /> Telephone Telephone <br /> Date I Date <br /> (For 1)tva nenw 11dbnW iM Copies sent ) <br /> 4 -d 00L0 956 6OZ ON 3OV WO2d Wdvs:z; 9661-90-6 <br />