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MAY-17-2005 16:45 ''OMBRIA P.02i02 <br /> State of California <br /> DeparEment of Water Resources <br /> Central District <br /> 3251 S Street <br /> Sacramento,CA-95816.7017 <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGRSEMENT <br /> • Project �P.�I G2 LS.'�.• a'vl <br /> Location: <br /> County. �'uV! a�`�-�rl Contract Number. <br /> Request is made pursuant to Section 13751 of the California Water Code for permission to <br /> inspect or copy Water Well Wier's Reports which are on file in your office. <br /> In accordance with the requirements of Section 13752 of the Water Code, it is stipulated and <br /> agreed that such reports, or any copy or copies made thereof, will not be made available for <br /> inspection by the public but will be used solely by this governmental agency for making <br /> studies. If copies are made or takers, each copy will be stamped "CONFiDEaNTIAL" or "FOR <br /> OFFICIAL, USE ONLY" and will be kept in a restricted file, ac:.ess to which is limited to the staff <br /> of this govermental agency or to its contracted agents. Any cccies furnished to contracted <br /> agents must be returned to the Department of Water Rescurces, 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 <br /> permission of the owner of the well. <br /> ?,.,Yt��-!2�. �ny 1 Y'01/\YYl•��►'Ti"�-aG� � c����T-1 <br /> Contrac.ea Agent Gcvemmentai Agency <br /> 9�p x-101!i s S+ve. S.Ikk. 304 E. wtey*-kx. tri <br /> Address Address <br /> CA 94 t�(�8 c }gin, CA �3 �- <br /> _....Lfi;,_State, B.Zip Cc�!P _.G ..G�e, &Zip Code , <br /> By C�,�Z-- By <br /> Officer . <br /> '` O �eGf C�ev l�g tS� Sen i or " H S <br /> lltle Title <br /> (5+0 ► <br /> (59-! - 98 (sogl 4 G 8 - 3454, <br /> Telephone elephone <br /> 205 Mav is , 2. d 0 E <br /> Date Date <br /> (Far Deparimer tai W=aftL copies Sent <br /> TOTAL P.02 <br />