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02/28/01 WED 10:29 FAX 1 916 861 0430 SECOR=SACRAMENTO 0 002 <br /> :£NTRRL DISTRICT x1 :227-7600 JUN X96 14 :58 No .011 P .02 <br /> State of Callfomla <br /> Department of Water Resources <br /> Central DlsWct <br /> 3251 3 Street M <br /> Sacramento.CK-65616-7017 <br /> WELL DRtLLEWS REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project sm-f <br /> Location:l,Q 'sa C Q &ltAir.r ,►t_�&w L LCC.k— <br /> County_ )8ibn , Contract Number. U 1". <br /> Request is made pursuant to Section 13751 of the California Water Code for permission to <br /> Inspect or copy Water Well Drllier'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 and <br /> agreed that such reports, or any copy or copies made thereof, will not be made available for <br /> inspectlon by the public but will be used safely by this governmental agency for making <br /> studies- If copies are made or taken, each copy will be stamped "CONFIDl=NTIAL" 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 pubrished without the written <br /> permission of the owner of the well. <br /> Contracted Agent -overnmentaI Agency . <br /> 2m IgmYSA Sw-'-ir <br /> Address Addres3 <br /> & L-T I <br /> C"Nd—"Adja <br /> NJty.Stat. _7ip Code 1� — .CtJY LSat ZIP. <br /> eyr-IuAle-tb �Y1S�CJV1 C►UUI�7 By. <br /> Officer ffice <br /> Title Title <br /> Telephone Telephone <br /> Qate Datra - <br /> (For oap Am*r W lofonrsadw: cry said <br />