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r.EhJTt;HL LSI TF'I<<T IL - i]ij v • 11 hdr, , �:+j:i4 F , ill <br /> State of California - <br /> Department of Water resources :. <br /> Central District <br /> 3251 S Street <br /> Sacramento, CA 95818-7017 Y, <br /> WELL DRILLER'S REPORTS =' <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project. TP'uc:� ..4v a S7 ea-ec 2,c)d 0- WL0 5fe� <br /> Location: 10 G,-c&,„t L{-v,,c koc,4-Tv-m <br /> County: 5 CAIvk TdaA_t'VA 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 ary copy or copies made thereof, will not be made available for <br /> inspection by the pLblic but will be used solely by this governmental agency for malting <br /> studies. If 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 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 tha well. <br /> W trt' l\fi r►A\Jr61L J 1-14EiAJ-,J S"-L),c,2,4 1 t6l&Hew[jr S Wiiz-Et <br /> Contracted Agent Cr Governmentaly <br /> �" Agency(a)7 <br /> `-7 � <br /> Aadre33 Address <br /> 7vz�kc. C-14 95 37 6 S +04-x. CA 15 Za Z_ <br /> City, State. &.Zip Code W CIP1. state. &Zip Cade <br /> By w(:'-G clS fVOe r' d-1 W ell-P-t (�AU,'11' By k10 V-)M L1�4ev/.0 <br /> Officer a Officer ' <br /> �U)[u f Sty�, L)- kye z f 6�S t <br /> Title <br /> Title <br /> r— <br /> Telephcne Tefepnone <br /> TO-41-1 too <br /> Data Date <br /> (For Owartrnental information: =010*Hni <br />