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06/03/2003 10:55 91686100-9 SECOR PAGE 02/02 <br /> in� so .1.14 svo .U11 P .U2 <br /> State of CallfOrnla <br /> bepartmesit of Water Resources <br /> Carinal District <br /> 32518 Street <br /> Sacramento.CA'-858t5-7017 <br /> WELL DRILLER'S REPORTS <br /> INSPECTIONREQUEST AND AGREEMENT <br /> Location: CX71 <br /> County: SaACaea Gefftract Number: <br /> Request is made pursuant to Section 13751 of the Califomfa Water Code for permission to <br /> Inspect or copy Water Well DdIler"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 anQ <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 worm by the contracted agent_ <br /> No information contained in these reporls can be disseminated cr published without the written <br /> permission of the owner of the well. <br /> Contracted Agent Governmental Agency <br /> 30/?- 41 . .kpv _ y - <br /> Address - <br /> + Ad res9 ' <br /> 7 cel3Ck41zWN <br /> / -City, State. &.Zip Com .. City..State..&Zlp.Coae <br /> SY koc,A-, By A:Y <br /> V�.Q14) 6-4ol <br /> OfficerQffic r <br /> S <br /> i64 <br /> Title Title <br /> / C� on JS Gil. 033 J <br /> Telephone �esepnone <br /> �ui't!Z 20 <br /> .cyete Data e <br /> {For OcRitrwU IMS: raples sx�t--- � <br />