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9-11-1996 3:OSPM FROM HORIZON/ELDORADO 916 939 2172 <br /> w sow <br /> State of California <br /> Department of Wafer Resources <br /> Central District <br /> 3251 S Street <br /> Sacramento,CA'-95816-7017 <br /> WELL DRILLERS REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project: _—. U 4-rn.MeL — <br /> y Location: !�� � <br /> County: v _ Contract Number: <br /> Request is made pursuant to Section 13751 of the Califcmia Water Code for permission to <br /> inspect or copy Water Well Driller'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 but will be used solely by this governmental agency for making <br /> studies. 1f 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 famished 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 cr published without the written <br /> permission of the owner of the well. <br /> r caju 14Xa �u - <br /> Contrac:ed Agent -avernmentai AgeYcy <br /> 5bl( &o0 4.4j) 301 ,6- 1.,/-Q- _A �''�c�•o <br /> Address Address <br /> coo 4.115 . r—A q 5-ry 2- c� eV Y500 Z <br /> iZty, State, V.Z p Code _ —..C ty, ate,.&Zip-Code <br /> Byit�l�cfr� �=Jtt�_ffe� _ BY QCs <br /> Officer officer <br /> I <br /> Title Title C,� <br /> �/ / <br /> (`�/�C) X39- � 7C�1 � r�� 16F- ��� <br /> { Telephone / �+ Telephone f�G� <br /> l 'Jri PIF` �{ - 19?lam // /. / <br /> r <br /> Date Oate <br /> (For Depwhnerdal lnfwmatlon: copies sent^ ) <br />