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06/21/2000 15:26 2094671118 AGE STOCKTON <br /> State of California <br /> Department of Water Resources <br /> Central District <br /> I 3251 S Street <br /> Sacramento, CA 95816-7017 j <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST .AND AGREEMENT <br /> I <br /> Project: <br /> Location: -7?' <br /> County- Contract Nurnber: <br /> Request is made pursuant to Section 13751 of the California Water Code for pen-nission to inspact or copy � C <br /> Water Well Driller's Reports which are on file in your office. I <br /> In accordance withthe requirements of Section 13752 of the Water Code, it is stipulated and ag.c-� I' <br /> reports, or any copy or copies made thereof, will not be made available for inspection by the <br /> be used solely by this governmental agency for making studies. If copies are made or taken- each copy .., .; <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 govenunental agency or to its contracted agents. Any copies iur6shed 1 <br /> to contracted agents must be retained to the Department of Water Resources, Central District upon ccmpletior ` <br /> of work by the contracted agent. <br /> i <br /> No information contained in these reports can be disseminated or published without the written permission of <br /> the owner of the well. <br /> Cart <br /> �•1—O'rl t'Y1 La <br /> Contracted A ennt ` CoUrninental Agency <br /> lam"" <br /> Address Address <br /> f � <br /> City, State, Zip Code City, State, Zip Code <br /> 9 _ l <br /> v 4 Bv <br /> Officer Officer —— — <br /> E-1 ls_ <br /> Ti Intl, <br /> Telephone Telephone <br /> as I o .a <br /> Date Date <br /> (FwDepwimcnulIntormaiion: „ -capitst ) <br />