Laserfiche WebLink
State of California <br /> Department of Water Resources <br /> Central District <br /> 3251 S Street <br /> Sacramento, CA 95816-7017 <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project: S <br /> Location: S W - " <br /> County: Contract Number: <br /> Request is made pursuant to Section 13751 of the California Water Code for permission to inspect or copy <br /> Water Well Driller's Reports which are on file in your office. <br /> In accordancewith the requirements of Section 13752 of the Water Code, it is stipulated and agreed that such <br /> reports, or any copy or copies made thereof, will not be made available for inspection by the public but will <br /> be used solely by this governmental agency for making studies. If copies are made or taken, each copy will <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 governmental agency or to its contracted agents. Any copies furnished <br /> to contracted agents must be returned to the Department of Water Resources, Central District upon completion <br /> of work by the contracted agent. <br /> No information contained in these reports can be disseminated or published without the written permission of <br /> vM;(, }J2oNN Selviu <br /> the owner of the well. t° <br /> �^ �"` _1 EovipAMQR�('! <br /> NI SAN �IoABJIn CVd-, HEALT4 DIV. <br /> vAUcf� Co n�;�onM�A'�A Znr . <br /> Contracted Agent Governmental Agency <br /> lal So,,7d Iu;JSon Wa., 30U F. WF6Et, %EI;Ro /ooR <br /> Address Address <br /> STocK-Mn CA- g5z4)a �TocISIOn/ , CA 9520;� <br /> pCity, State, &Zip Code Chitty, State,Zip Code <br /> Officer Officer <br /> 5TA FF Ci e r a a(S i SP, ECK-2 <br /> Title Title <br /> 20`1 ) Y6 -7 10(A �& 03r{2 <br /> Telephone Telephone <br /> �5- ► !) - 9R &)- 10b <br /> Date Date <br /> (For Departmental Information:_Copies sent ) <br />