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NOO-30-2000 16;04 rRMBRIR INC. 1707 935 6649 P.02i02 <br /> state of California <br /> Department of Water Resources <br /> Central D"Istria <br /> 3251 S Street <br /> Sacramento, CA 85816.7017 <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> project S`R - �JrQ.^fT�6� 1.5 Oil <br /> Location. 2'A O° %i E - Er"R-Y sty-, 1-41 5106<1'Oh <br /> County. �.� n Cou fi Contract Number. <br /> Request is made pursuant to Section 13751 of the California 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. If copies are made or taken, each copy will be stamced "CONFIDENTIAL" or "FOR <br /> OFFICIAL USE ONLY" and will be kept in a restricted file, access to whic` is limited to the staff <br /> of this govermental 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. <br /> ti.4" Cm wn�� Rkm�C <br /> Contracted Agent C-cvemmentai Agency <br /> 2?c) ?qxKh5- srt ree� d� �. a!e�, 3 c <br /> Address [[ Address i <br /> SohO'ctic,fC� �Sy76 G•�1'l/n, �• //�Z � tj �' � <br /> -- -ciy-State. &.Zip Ccde cxi,_SIlre, &Zio Code itl <br /> Sy ,Cyti,C�.;o`yask <br /> 4 ey tt� <br /> a <br /> Officer w 1;Acer `� q <br /> 1 /C. /7• �l0�/ � <br /> Ti Title E <br /> a o o R <br /> L071 <br /> Telephone Telephone I: <br /> � Do <br /> Date Date <br /> 0 <br /> Z <br /> x <br /> (lar O�rytrrynpl Irt/anrfltlon: y,_oopb3 dent 1 LL <br /> n z <br /> N O m a <br /> TO <br />