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AGE STOCKTON <br /> PAGE 02 <br /> 1'15/16/2003 10:00 2094671118 NNW <br /> State of California <br /> Department of Water Resources <br /> Central District <br /> 3251 S Street <br /> Sacramento, CA 95816-7017 <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project . rr ' <br /> Location 3093 /ll 4(,2taf-s hm 4- , <br /> County: A&. oQopiea, - Contract Number: <br /> Request is made pursuant to Section 13751 of the California Water Code £or percussion to inspect or wpy <br /> 'Vater Well Driller's Reports which axe on file in your office- <br /> In accordance with the requirements of Section 13752 of the Water Code, it is stipulated and agreed that such <br /> reports, or any copy or copies made thereof, will not be made available for inspection by the public but will <br /> be used solely by this governmental agency for making studies. If copies are made or taken, each copy Y611 <br /> be stamped"CONFIDENTIAL"or"FOR OFFICE USE ONLY"and wall be kept in a restricted file,access <br /> to NOuch is limited to the staff of this governmental agency or to its contracted agents. Any copies furnished <br /> to contracted agents must be returned to the Department of Water Resources, Central District upon completion <br /> of work by the contracted agent- <br /> No information contained in these reports can be disseminated or published without the t�Titten permission of <br /> the owner of the well. <br /> 4hwaall C eo ijmyiK.tpd_�al,rife S'dn joQoS1Lrtcou Enyironmerx 4I <br /> Contraaed Agent mea li-h Buee. GovermAental Agency <br /> R-?7 3 hA,( c_ getd 3o+ E. Weber Ave. a+ocA+gaiG/4 <br /> Address Address gS-202 -2708 <br /> 4[rAlah, M 952/5 :3+,).--P-t-,� CA qg=-29vg <br /> City, State, &Zip Code City, State,Zip Code y <br /> �=or ia� S kEn>rironmeAl He41A Seec%alisf <br /> �— 'title Title �— <br /> (M) 967—/ap4, 12091 46 8 - 3456 <br /> Telephone Telephone <br /> -5/a/&-3 _ 5'I /G L03 <br /> bate Date <br />