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_11/17/97 KION 16:46 FAX 1 415 882 ]673 002 <br /> CENTAL DISTRICT ID :2 -7600 NOV 1 ( '9( 14 : 4 1,4u .ulu r .0 <br /> State of callfomis <br /> Depmrtrngnt of Water Resources <br /> Central District <br /> 32518 Street <br /> Sacramento,CA 95818-7017 <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project: <br /> Location: 6 /� ti S �v UJ <br /> County: C,n J �7i Contract Number. <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 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 the well. <br /> h Contracted Agent Govemmental Agency, <br /> U`l <br /> Iy taw r'v`sVl �d✓�/j/iJj S r 3�4 C . �EL'�E� ,L�V6 <br /> Adores@ Address <br /> ,Sc AJ-A/e\VLCA' s c,o ,( A C* <br /> City, State, A.Zip Code City, State, i Zip Code <br /> BywiiL� j � �y �,,,,., <br /> otrfc.r officer <br /> TWO Title <br /> (, iI j) eu� <br /> Telephone Telephone <br /> i i 11 k-/ nr -- <br /> Date Date <br /> (Fa Oepeipnerdal troaraa ": @@pies <br />