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Oct 18 01 03: 44p Ho- 4zon Env. Inc 91R ''39 2172 p• 2 <br /> State of California <br /> Department of Water Resources <br /> Central District <br /> 3251 S Street <br /> Sa=rnento,CA-35815-7017 <br /> WELL DRILLER'S REPORTS <br /> 0j;?4&07, <br /> INSPECTLIO,.,N;,REQ�U/EST AND AGREEMENT <br /> Project: sh(, �'� !1lO• <br /> Location: ! � &ey� 4em— <br /> County: <br /> Contract dumber: Ir� , <br /> Request is made pursuant to Section 13751 of the California Water Code for permission to <br /> inspect or copy Water Well Drillers 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 /> inspection by the public but will be used solely by this governmental agency for making <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 retumed 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 pubiished without the written <br /> perrnlssion of the owner of the well. <br /> Contracted Agent Governmental Agency <br /> Address Address! <br /> City, ' +e. 1lp r-^ e - C�tate, $Z!n CiH� <br /> B &�a ��y ey ALd,,4�� <br /> Otriicer Of ricer <br /> Tide V Title <br /> Telephone Telepnane <br /> ' 60 f I? 2�vo y <br /> Date Date <br /> (For Departmental intaznatlan. aopks sent ) <br />