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N 05 / 31 / 01 THU 14 : 21 FAX 1 916 861 0430 SECOR- SACRAMENTO Ia 002 (, INI VIAL 1) 1 lnru , rl - � � iu � u Zvi . • ., . .. . .. . . . .. .. Stale of Callfomla Department of Water Resources Central Dlstrid 3251 8 Street Sacramento, CA` 9581 &7017 WELL ORILLER• S REPORTS INSPECTION REQUEST AN1DA� G�REEMnN� T Locat on : l D � � �VhQX� fD K F)i t • U_ y_�_(1��_-- County, Contrad Number "f+ , o�l"J J gyp) I (� Request is made pursuant to Section 13751 of the Celifomla Water Code for permission to Inspect or copy Water Well Drillers Reports which are on file In your office . In accordance with the requirements of Section 13752 of the Water Code , it is stipulated and agreed that such reports , or any copy or copies made thereof, will not be made available for inspection by the public but will be used solely by this governmental agency for making studies . If copies are made or taken , each copy will be stamped "CONFIDENTIAL" or "FOR OFFICIAL USE ONLY" and will be kept in a restncied file , access to which is limited to the staff of this oovermentat agency or to its contracted agents . Any copies fumished to contracted agents must be returned to the Department of Water Resources , Central District upon completion of work by the contracted agent. No information contained in these reports can be disseminated or published without the written permission of the owner of the well. c�rh^ 1fN h . _ v I snrn�a�► n �i A� 1 Flr� Governmental Agency Contracted Agent 9 y - U Address Address dzVA , UA 010 S= A[SYIa.( 1 �� ,, .-City, State, & _ip Code City, Staa ej„ & Zip Code BY �1�Ll "�l ev�hu i S By Lj(�,, � 1C Officer Officer _ (/� 1 Title pTrtle2� � 1 ' ^ 1 l Y 1Q0 (, Telephone Telephone 161 ate Data (For Oe Wrlr^�rd r Infartnatlon: _ copf�c � )