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02/07/2065 23:34 20'33671 F[7 THILL ENGINEP4NG PAGE 02 <br /> CENTRAL DIS T 4IwT 22?-?Fi(�(r r -• f kti U NQ Ljtjz r .uc <br /> M XP Q?CA'W23HI6 Y RAY <br /> DEPARTMENT OF WAI LR RESC7URCES <br /> CENTRAL DISTRICT NORTHF;RN DISTRICT SAN MAQVIN DISTRICT SOUTHERN DISTRICT <br /> 32515 Street 2440 Mein Street 337o Foal Shields Avenue 770 Fainnorv!Avorrue <br /> SoorAmento,CA 9681$ Rod stuff,CA 90090 Froi rso,CA 93126 41e►nddle,CA 91203 <br /> i�)22!•9992 {59C;WR-7"o (669 230-poo (619)443-AWO <br /> i8G1a)227-iA00(FaXl (634;63 7322(Fel) (650 230.3300(fall (61 Es}643-4904(Fac) <br /> WELL COMPLETION REPORT RELEASE AGREEMEW-•AGUNCY <br /> (Govornm®>tt tnd Regulatory Agencies and thi*Authorlred Agents) <br /> Proiect/ContraO NO,,�[Q CL Countk <br /> 1 <br /> Tawnshlp,Range,and Section a, Q _ - _Ratldlus_,ZQ(72 <br /> (Ws1 innlud6 ar%tlre study Brand a f e*that a llmO 4 Inten",1,1 <br /> .} <br /> Under CaiifOrnio Water Code Section 13752,the age ey arnW below requests permiselen from <br /> Depecment of ,well Com lation Repoater Resourcos to rts filed pt or ursu tt o otlon 3761 agentr avilhodzed (check ort 3 Mow to <br /> Inspect or copy, � <br /> Make a study, or, <br /> Perform"en environr-..0Mtnl cle ariup study ass c!ated with an unauthorized ralea"of a <br /> contaminant within a distance of 2 miles. <br /> In,accordance with Seotion 43752, information obtained f^orn these reports shall be kept oonfidtmtial <br /> and steall not be disseminated,published,of made a silatle for Inspection by the pubile without <br /> written authorization from the owner(s)of the woll(s), The information 3hd11 be rased only for ttre <br /> purpose of conducting the study. Copies obtained sail be stamped CONF09"AL and shall be <br /> kept In a restriefed file accessible only to agency ate ar She outhotized agent. <br /> I E N QZIVJ� _ N u:A/ C 611—b <br /> Authorized Agent Government or egulatory Agonvy <br /> f,,�7o <br /> ,00 '_ 3° 67 W� . ter, <br /> Address A dress <br /> a d� Al7.7 <br /> City,S e, ip Code CI ,State,and Cada <br /> ig n to r <br /> Tylephoyw titc�n�j�.."gLp4 c� <br /> x 124 <br /> UP-,77= - G 3 <br /> Data 281'a <br /> �I! J QC � �� � �' f <br /> r __114 <br /> 6 June 2001 <br />