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OB/ 28/ 2001 14 : 41 20946711Ar4 AGE STOCKTON .-r- PAGE 02/ 02 <br /> State of California <br /> Department of Water Resources <br /> Central District <br /> 3251 S Street <br /> Sacramento, CA 95816-7017 <br /> WELL DRILLER' S REPORTS <br /> ppINSPE�CTION REQUEST AND AGREEMENT <br /> Project na cY l� rtic <br /> Location: IZ-0I SC200� CCnAer ST <br /> County: S & Jon - b <br /> � ContractNumber: RCpE - AtG ^ caa - 7L � <br /> Request is made pursuant to Section 13751 of the California Water Code for permission to inspect or copy <br /> Water Well Driller's Reports which axe on file in your office, <br /> lu accordance txith 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 govermnental agency for making studies . If copies are made or taken, each copy will <br /> be stamped "CONFIDENTIAL" or `Toll OFFICE USE ONLY" 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 fumished <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 information contained in these Feports can be disseminated or published without the twitten permission of <br /> the owner of the well. <br /> r <br /> Pr15 •6W�Y <br /> A�Uan oQ eo1� <br /> Contracted Agent Governmental Agency <br /> gay SkIi. �R�. _ 41.e 34"4lrc <br /> Address Address <br /> S}Qc 6A ,. CA 95a is _ �j'�«.0 eo*. 95zoZ <br /> City, State, & Zip Code City, Stk, .Zip Code <br /> Y3v le ZUJ04� (a <br /> �` fficexl fficer <br /> C... nuif0 ''tr"12V17aI SPC'Cra �rSrLO? <br /> k6" <br /> sip f� <br /> Tule Title <br /> q (-o -7 - /taco ( 2CV 3V551 <br /> Telephone 'Telephone <br /> Tj0 0 <br /> Date Date <br /> (For Deparimullal Worm tionti,.,`Cop�a ,�,�i_ ) (� <br /> 1 <br />