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08/14/2000 12:42 2094671• AGE STOCKTON PAGE 03/03 <br /> State of California <br /> Department of Water Resources F6M <br /> Central District <br /> 3251 S Street <br /> Sacramento, CA 95816-7017 <br /> WELL DRILLER'S REPORTS <br /> INSPECTION REQUEST AND AGREEMENT <br /> Project (�O r <br /> Location: 4 142 We 51- xP un r 4 jCad <br /> County: �as2>2� Contract Number: <br /> Request is made pursuant to Section 13751 of the California Water Code for pemtission to inspect or copy <br /> Water Well Driller's Reports A%i ich are on file in your office. <br /> bi accordance ititli the requirement of Section 137.2 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"CONFIDENTLkL"or"FOR OFFICE USE ONLY"and will be kept in a restricted file, access <br /> to tiirich is limited to the staff of ibis goverumental agency or to its contracted agents. Any copies furnished <br /> to contracted agents must be retumed to the Departriant of Water Resources, Central District upon completion <br /> of work by the contracted agent. <br /> No infonnation contained in these reports can be disseminated or published without the written permission of <br /> the owner of the well. <br /> Contracted Agent Golcnnnenta]Apency <br /> Address Address <br /> c A A", ?�s/s <br /> CiTy.S121e2 &Z;p Code ! 0 Cin', Stmt,Zip Code <br /> g� f o1ri it LA,,,, C. <br /> Officer V I I 05fficer <br /> Tide 7 Title <br /> )Z7 /Y2r,� <br /> Telephone Telephone <br /> c ,' -00 AUG 14 2000 <br /> Dace Date <br /> {For DcPe M rrul rn mul;on: c0p;M scil ) <br />