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11/10/1999 18:39 2094671118f"-lI AGE STOCTON PAGE 02 <br /> I <br /> State of Califorhia <br /> Department of eater Resources <br /> CeAtral District <br /> 3251 S Street <br /> Sacramento, CA 95816-7G17 <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AICD AGREEMENT <br /> Praject b (40p— <br /> Location: <br /> 0Location: s 17-01 QST Jatmv L k Le(i i CA. <br /> County: Contract Number: <br /> Request is n' lade pursuant to Section 13751 of the California Water Code for pemtission to inspect or copy <br /> Water well Driller's Reports v Bich are on file in yotir oflice.. <br /> i <br /> In accordance)Kith tkke requirements of section 13752 of the Water Code: it is stipulated and agreed that such <br /> reports, or any copy or copies inade thereof, will not be made available for inspection by the public but N-611 <br /> be used solely by this govemintntal agency for making studies. If copies are made or taken, each copy%xil1 <br /> be stamped"CONFIDENTIAL"or"FOR OFFICE USE ONLY"and will be kept in a restricted file. access <br /> to vJiiclt is}iniited to the staff of this govenimental agency or' its contracted agents. rS►r1y copies furnished <br /> to contmct�4 agents must be resumed to the Department of Water Resources, Central District upon completion <br /> of work by 6e contracted agent. <br /> i <br /> No infomiat on contained in these reports can be disseminated or published vit)taui the written permission of <br /> the ov.ttt:r afthe well. i <br /> I <br /> Contracted ASeait Governmental Agcy cv <br /> I <br /> 905 cr w► A —.I o - aA.4- <br /> Address Address <br /> C q 5 Zoi 7"rdlam_ C& �_r)j Z <br /> City- State, &Zip Code City, State,Zip Code- <br /> B171^� v l <br /> Officer Officer <br /> kze-45 <br /> Title Title <br /> Telephone Telephone <br /> Date Date <br /> (Far Drpaurtr stmt sent } <br /> i <br /> I <br />