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08/20/2003 10:59 9168610430 SECOR PAGE 02102 <br /> State of catllomla <br /> ❑apartment of water Rdsoum4s <br /> L;ardrat Olslrict <br /> 3251 S stmal <br /> 5acremento.CA-85846-7017 <br /> WELL DPJLLER`S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> County: v� 0. ca i/l Cantrac#Number <br /> Request is made pursuant to Section 13751 of the Cs[ifornfa Water Code for permission to <br /> Inspect or copy Water Well Drlfles`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 /> inspealan by the public but wtil be used solely by tris governmental agency for making <br /> studies, tf copies are made or takan, each copy will be stamped "CONFIDENTIAI-" or "POR <br /> OFFICIAL USE ONLY' and will be kept in a restricled 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 Wager ResourcEs, Central District upon <br /> compietion of work by the contracted agent. <br /> Na information contained in these reports "n be disseminated cr published without the written <br /> permission of the owner of the well. <br /> Con"etedAgent -av¢rn tatAgcncy�• <br /> Address Address <br /> 44 <br /> CA- 9G-SLOI <br /> -City,States Z1a Co6e _ _..City-state_& zlp.cade <br /> By <br /> Olficor Officer <br /> Title T"rtie <br /> C661 uL�0-0 ex:t. Z2-4 44 Co$ - 0-53-7 <br /> Telephone Telepti6no <br /> 2 a 2L703 --,zCO 3 <br /> Data Data <br /> (For oapwt u aril Wdbr n tdoa- _capLQ tart <br />