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D�2 <br /> 12/30/96 14:33 GR,�,S]—SACTO <br /> lCEPaT 'Fti 11I:DTPI' T __ <br /> 1 :v1 1•�ct .i3]4 P .02 <br /> Stale of callfamla <br /> Department of Water Resources <br /> Central District <br /> 3251 S Street <br /> Sacramento, CA 95818-7x17 <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project, no cl t <br /> Location: <br /> County: —iSw_ Contract Number: _..jz2 e/ <br /> Request is made pursuant to Section 13751 of the California Water Code for permission to <br /> Inspect or copy Water Well D61jer'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; liut will be used solely by this governmental agency for making <br /> studies. If copies are made or taken, each copy will be stamped "CONFIDENTIAL" or "FOR <br /> OFFICIAL USE ONLY" and will be kept In a redtrlcted file, access to which is limited to the staff <br /> of this govermental agency or to Its contracted agents, Any coples 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. <br /> -- ntractMd Agent — ernmental Agency <br /> Address AddrOSs <br /> city, ale. $.Zip code City, State, &ZIp Code <br /> i <br /> By /04.0 <br /> 0mcer officer <br /> Tift Title <br /> Telephone , Talophone <br /> Oaie., gate ` <br /> (for Dppaitmontal info;Tnevon, _T copies sent _ } <br />