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06/13/2003 14:09 2094671't.8 AGE STOCKTON PAGE 02/02 <br /> %./ <br /> State of California <br /> Department of Water Resources <br /> Central DistAct <br /> 3251 S Street <br /> Sacramento, CA 95815-741.7 <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND ,A►GREVVIENT. <br /> Frojeat• 'a)( <br /> Location: <br /> County: 25ri yl `` _ Contract Number: <br /> Request is made pursuant to Section 13751 of t1--c California Water Code for perp issim to inspect or copy <br /> Water Well Driller's Reports which are on file in your office. <br /> In accordance with the requireanents of Section 13752 of the Wates Code; it is stipulated and agreed that such <br /> reports, or any copy Or copies made thereof,will not be made available for uyspection by the public but will <br /> be used solely by this governmental agency for making studies. If copies are made or taken; each copy will <br /> be stamped"CONFIDEN LLL"or' OR Ol~FTCE USE ONLY"and will bekept itt a restricted file; access <br /> to'Mich is liiruted to the staff of this governmentll agency or to its contracted agentq. Any copies furnished <br /> to conuwted agents must be returned to the Depaitnem of Water Resources, Ccontral District upon completion <br /> of work by the contracted agent. <br /> No infotntataon contained in these reports can be disseminated or published without the.iv rittepermission of <br /> the owner of the well_ <br /> Contracted Agent Governmental,Age�n-7cy <br /> J30 L6Je[Jty 4e,r <br /> Address Ad dmss _.. <br /> �41 <br /> City, Stat ,dt zip Code City, State zip Code <br /> Officer Officer <br /> .hLae j <br /> Title Title <br /> W) qtn <br /> Telephone eleph g <br /> Date Date <br /> OFw A�sstt�t.!Yntonmat:w: Copim sent__ ,� j <br />