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10/12/98 MON 11:52 FAX GROUNDWATER IM 003 <br /> r <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 /> INSPECTION REQUEST AND AGREEMENT <br /> Project <br /> Location: <br /> County: SGi/, A, "� Contract Number. <br /> Request is made pursuant to Section 13751 of the California Water Code for permission to <br /> inspect or copy Water Well Drillers 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 taken, each copy will be s:�amped "CONFIDENTIAL" or "FOR <br /> OFFICIAL USE ONLY" and will be kept in a restricted file, access to which is limited to the staff <br /> or this goverrnentai agency or to its contracted agents- Any copies furnished to contracted <br /> agents must be returned to the Department of Water Resources, 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. I /� <br /> ` • � �� ���J u�c Cd -G%ff <br /> �j <br /> Contracted Agent /G,ovvernmental Agenccy� <br /> Address —�� Addres <br /> City,State, &.Zip Code C ,state,&Zip Code <br /> By >��P�1/-er B� � <br /> Officer Officer <br /> Titi� Title <br /> 37o -3,9 Y61 (6 %W <br /> i eiephone Telephone <br /> A/- /21 z <br /> Ir V <br /> Dale Date <br /> (For DepanawntaI Iniorrnaiion: copks sen j <br />