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• State of California <br /> f Department of Water Resources <br /> Cvhtral District <br /> PR 0 6 1999 c Street <br /> Sacrr-. _.. 45816-7017 <br /> I-IEl+ APR 0 91899 <br /> AIT 1 SERVICFS WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project; G t 1,e5 I Y L cG % <br /> Location: _ 3q 31 N Aw 4s� �Z£ . Stacks n <br /> County: So-, So o i� Contract Number: <br /> Request is made pursuant to Section 13751 of the California Water Code for permission to inspect <br /> or copy Water Well Driller'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 of copies made thereof, will not be made available for <br /> inspection by the public but will be used solely by this government agency for malting studies. If <br /> copies are made or taken, each copy will be stamped "CONFIDENTIAL" or "FOR OFFICIAL <br /> USE ONLY" and will be kept in a restricted file, access to which is limited to the staff of this <br /> governmental agency or to its contracted agents. Any copies furnished to contracted agents must <br /> be returned to the Department of Water Resources, Central District upon completion of work by <br /> the contracted agent. <br /> No information contained in these reports can be disseminated or published with the written <br /> permission of the owner of the well. <br /> Uygradient Environmental Consultants I}S - I{ D <br /> Contracted Agent / Governmental Agency <br /> C36'. 7,00y <br /> Address Address <br /> CcvK� ,,c — V,.rL C `tS66-Z S aC( �e�— Ck- �t5� <br /> City, State&Zip Code City, State&Zip Code <br /> By V t crate 'L - By- ` � eikE-H <br /> Officer o cerEH S �> Q <br /> Title Tide <br /> ��--7,z-362c _�4 �6g�03� - <br /> Telephone Telephone <br /> `lam.... / C-1 /R <br /> Date Date <br /> (Fn pep annuml Ldbrmelim: capita not ) <br />