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State of Califomia <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 Ccnr rear <br /> Location oaZ asc ' ,5�4�7ar7 CA <br /> County Contract Numbe- <br /> Request is made pursuant to Section 13751 of the Califomsa Water Code for permission to <br /> 'nspAct Or copy ��,,..1 r ,A r, � ' _ <br /> W8 I+ Vr i+ie s Reports wnich are cn Elie in your office <br /> In accordance with the requirements of Section 13752 of the Water Coae, it is stioulatea and <br /> agreed that such reports, or any copy or copies made thereof, will not be made availaole for <br /> inspection by the public but will be used solely by this governmental agency for making <br /> studies If copies are mace or taken, each copy will be stamoee "CONFIDENTIAL" or "FOR <br /> OFFICIAL USE ONLY" and will be kept in a restricted file, accass to which is limited tc the staff <br /> of `his govermental aeency or to its contracted agents Any copies fumished to contracted <br /> agents must be retumec to the Deoartment of Water Resourc-es, Central District upon <br /> completion or work by the contracted agent <br /> • No information contained in these re orts disseminated can be dl - <br /> P ted ar puolsshed without the written <br /> permission or the owner of the well <br /> e. <br /> �sr'4 <br /> Can rac;`a Anent C-overnmental aenc� <br /> ' <br /> Actress �•• 1-b Accr--, <br /> ?1647 ?�52,aZ <br /> Clzy, state Za Caee �� <br /> City, State Zlo Coae <br /> By B <br /> r icer y <br /> i rli$ <br /> Title <br /> f 1 <br /> i ele=vane Tekec%ane <br /> e r"z laet_ -7 . 1 / F,9 <br /> oate <br /> (For Qeoanmental informatic-i cooles sent <br />