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JUN <br /> k C�.NIl2f�L Ulslhilrl bUU <br /> State of Ga11('ornia <br /> Department of Water Resaurges <br /> F� Cantml DWr-t <br /> azsl s sveet <br /> Sacramento.CA'•15816-7017 <br /> WELL DRILLEWS REPORTS <br /> INSPECTION RSQUEST ANa AGREEMENT <br /> . p,roJect <br /> S <br /> C <br /> Contract Number <br /> County' �_—�---- <br /> Request ss made pursuant to s which aren file In your afflcede for permission to <br /> Inspect or copy Water Well Ddl er`s Report <br /> In accordance with the requiramenis of Section 53752 of the Water Code, it is stipulated and <br /> able for <br /> agreed that ,ucl,, reports, or any copy or Caples matte there �l <br /> ovmentall not e gencyafor l mak:jng <br /> inspection by the public but will be used sorely by his gE <br /> studies. if copies al-9 :-nada or taken, etch copy will be stamped "CONFIDENTIAL" or "FOR <br /> OFFICIAL USE ONLY" and will be kept Via restricted file, access to which is limited to the staff <br /> ny <br /> of this must e- ai returned <br /> et rnedy for to the Department off WGterARes pcE5.les umished to Central Districtracted <br /> pon <br /> agents r[lusi b <br /> completion of work ry fhe contracted agent. <br /> No information contained in these reports can be disseminated or published without the written <br /> permission of tha owner of the well. <br /> CQ2 lelt>IcLTI - CovernmentaiAgency <br /> Coy trac:ed Agent 8 <br /> er <br /> Address <br /> Address <br /> 0 _.:City.. tate,.8 ZIp.Code .. <br /> -S�i:y, Stam,82!p Code . <br /> BY f,, —v.. Officer ---�. <br /> Offcn[ <br /> "citta <br /> iitl a <br /> 'iTelephone <br /> etephone <br /> DRXa <br /> psi <br /> (Pa 04wownw Imo; 1— <br /> Z0/Z0 39Vd 8003S OE1201989T6 00'TT £00Z/ZT/90 <br />