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D1/07/00 14:09 FAX <br /> a <br /> T p r:_ : - T <br /> State of C$llf0mis <br /> Department of Water Resources <br /> Central District <br /> U61 $ Street <br /> Sacramento,CA 95816-7017 <br /> WELL DRILLERS REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project' ft V:`t t-n C'5, <br /> Location: <br /> County: -' Ct ri Contract Number. , <br /> Request is made pursuant to Section 13751 of the Caiifomia 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 far <br /> inspection by the public but will be used solely by this governmental agency for making <br /> studies. If copies are made or taker:, each copy will be stamped "CONFIDENTIAL" or "FOR <br /> OFFICIAL USE ONLY" and will be kept in a restricted file, access to which is limited to the staff <br /> of this govermental agency or to its contracted agents. Any copies fumished to contracted <br /> agents must be retumed to the Department of Nater Resources, Central oistrict upon <br /> completion of work by the centmaed agent, <br /> No information contained in these reports can be dissamfnated or published without the written <br /> Permission of the owner of the well. <br /> tIr S a a 0-0,a to i^ <br /> tlr_lf�1* L{itu ti tl.`r � 1` t:�:.� _�l�°,�.FS <br /> Contracted Agent l overnmentai Agency C�mV t vco-, <br /> Aacress <br /> Address —` <br /> TiO 2— <br /> By <br /> , state. &_Zip cocle City. State, s Zip code <br /> 9 <br /> By City, vadal�r=L Ey rl A l/k-Clr(4— <br /> t�tSCB officer <br /> Tit{s ?itla <br /> rete nat,f <br /> P i alapnone <br /> r~s I l o o C7 <br /> nate —Tort® ' <br /> (For ownrtmental Intcam�atton: coptas Sart �_ } <br />