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' DEC 21 298 03 : 28PM CLER94ATER GR0LF F . 212 <br /> b State of California <br /> Department of Water Resources <br /> Central district <br /> 3251 S Street <br /> Sacramento, CA 95816-7017 <br /> WELL DRILLEWS REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project �f ��L ��`<- G tf � � i ± � Crt F,4ecc_ ITy / <br /> Location: ! 6 l 7 - 1` ff S L a C1 c'j t �IC. � °tpvo� <br /> County: �,., t ^ f aa, Q () AJ . Contract Number. <br /> Request is made pursuant to Section 13759 of the California Water Code for permission to <br /> inspect or copy Water Well Drillees Reports which are on file in your office, <br /> In accordance with the requirements of Section 13752 of the Water Cade, it is stipulated and <br /> agreed that such reports, or any copy or copies made thereof, will not he 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 "CONFIDEN`fiAL" 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 furnished to contracted <br /> agents must be returned to the Department of Water Resources, Central District upon <br /> completion-of .work by the car mcted agent, <br /> No information contained in these reports can be disseminated or published without the written <br /> permissien of the owner of the well, <br /> Contracted Agent Governmental Agency %At7 r _ <br /> r� { � F f� S t . 5z`i fOL4 3cticl 5 , we. be. ,r Air:i '71tvd A <br /> COLiC <br /> r., Address �.^ Address <br /> ` <br /> C9 �1�C ALAI t ]� C A 4 60 7 J d-e-f6t "A 21 (!�- ,4 LF5 Z d Z .- <br /> City, State, &Zip rCo(de /city. State, & Zip Code <br /> Officer offiver <br /> C6 C V Cc-6t L1 t to 1 <br /> Tine Title <br /> T16 tzoq ? `(b� o33 � <br /> Telephone Telephone <br /> S Ivl z 17Z <br /> Cate '—r ate <br /> (For cepaetntenlal lnfar acn: _wplessent ) <br />