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05 / 31 / 01 THU 1. 4 : 22 FAX 1 916 861 0430 SECOR- SACRABIENTO fa 003 <br /> N IINIhNL l/ CJI l I U i ! uuu ui . � •, <br /> state of California <br /> Department of Water Resources <br /> Central District <br /> 3251 8 Sheat <br /> Sacramento, CA , 05816-7017 <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> f n� e �t vt <br /> P� c e � l�kirn��l- Rl a32- <br /> Location: �� �r16auNky�� 7) <br />:I County: Contract Number. V 1� . � 1 <br /> Request is made pursuant to Section 13751 of the California Water Code for pe mission to <br /> Inspect or copy Water Well Dr111er's Reports which are on file in your office . <br /> f <br /> In accordance with the rcquiremanis 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 /> inspectlon by the public but will be used solely by this eovemmental agency for making <br /> n , each copy will be stamped "CONFIDENTIAL" or FOR <br /> studies . If copies are made or take <br /> OFFICIAL USE ONLY ' and will be kept in a restricted file , access to which is limited to the staff <br /> of this oovermentat agency or to its contracted agent=_ . Any copies fumished to contracted <br /> f agents must be retumed to the Department of Water Resources , Central District upon <br /> P 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. pac <br /> Contrac.ed Agent Covernmental Agency <br /> e <br /> I <br /> ` )d r ad _ VkbP+rAD <br /> Address Addr/es's� � ^ <br /> g F l o b <br /> (.� �" ✓!� <br /> malty, State, 8 7Ip ode _ . : City. State, . & kip. Code <br /> By By Off car <br /> Officer <br /> OMA SS <br /> II �/)Tile Title <br /> Telephone Telephone <br /> Date Dere <br /> WIN <br /> _ -^..,�MI Infamutlon: � sw4 <br /> (Far DaWNn.Nil _ <br />