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5-05-1997 2: 18PM FROM AGE NC 209 956 0700 P. 2 <br /> State of California tio <br /> Department of Water Resources <br /> Central District32S StreeF <br /> Sacramento, <br /> CA 95816-7017 <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project i <br /> Location• 5 ! �j )4 AN C <br /> County: tiam ,'[QA Ja-j;n Contract Number: <br /> Request is made pursuant to Section 13751 of the California Water Code for permission to inspect or copy <br /> 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 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 will <br /> be stamped"CONFIDENTIAL"or"FOR OFFICE USE ONLY"and will be kept in a restricted file,access <br /> to which 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 Departmatt 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 written permission of <br /> the owner of the well. <br /> //1i SAry J049&vin (0-04-t Pbliv <br /> A-AVR N,2D Geo !EAv1renmerH4 t6l+h 5etvtt" -F.w:mc. v"i 4"144 <br /> Contracted Agent Governmental Agency <br /> &6V L Acv e, SOY FtRs'7 W FAE1l. ay.?- <br /> Address <br /> v.e,Address Address <br /> Loo l . CR 54r-K-k0 Cor 95aoa <br /> City, State,&Zip Code City,State,Zip Code <br /> B� � C„e11aul _ <br /> Officer O cer <br /> 51AFF (;e-1"/57 SuOer ,: s i .1s l��H S <br /> Title Title <br /> tzot) 915 —OR b4 riot, 'Q8 - 3qY <br /> Telephone Telephone <br /> 05- 05-01-7 - 5 - 9 --2 <br /> Date Date <br /> (Fm Dap.&—tat Lf—%aU-,_Cop-raA <br />