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CENTFHL -bI":-:-TPICT 227-7 6 i;0 A Y 1-10 .004, P . 01 <br /> State of Callfomla <br /> Department of Water Resources <br /> Central District <br /> 3251 S Street 12: 0 7 <br /> Sacramento, CA 95818-7017 <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project: `s S I <br /> Location: I U le 0 g-c,-, 1--l-t- <br /> County. Ck r.\ "Y-0 Cl q LA—-,V-) 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 for <br /> inspection by the public but will be used solely by this govemmental 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 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 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 /> Wrlwh+ Gjrwwory-,ap-v�� Sp-cu <br /> Ili Contracted Agent Governmentai Agency <br /> 1n-7 IcAk stfep-� <br /> Address Address <br /> -Tracu (-(-\ q 3� (-10— <br /> State. &.Zip Code city. State, &Zip Code <br /> By A A^A Al <br /> By <br /> Office 9f Officer <br /> Pre si, ae C)-t- <br /> Title Title <br /> 33- () -7S-� <br /> Telephone Teieprione <br /> Date Date <br /> (For Clepartmental Information: -copies sem <br />