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STATE OF CALIFORNIA-THE RESOURCES AGENCY ARNOLD SCHWARZENEGGER Governor <br /> DEPARTMENT OF WATER RESOURCES <br /> CENTRAL DISTRICT NORTHERN DISTRICT SAN JOAQUIN DISTRICT SOUTHERN DISTRICT <br /> 901 P Street 2440 Main Street 3374 E. Shields Ave Ste A7 770 Fairmont Avenue <br /> Sacramento, CA 95814 Red Bluff, CA 96080 Fresno, CA 93726 Glendale, CA 91203 <br /> (916)651-0753 (530)529-7300 (559)230-3300 (818)500-1645 ext.233 <br /> (916)651-0726(Fax) (530)529-7322(Fax) (559)230-3301 (Fax) (818)543-4604(Fax) <br /> WELL COMPLETION REPORT RELEASE AGREEMENT—AGENCY STUDY <br /> (Government Agencies and their Authorized Agents) <br /> Under California Water Code Section 13752, the agency named below requests permission from <br /> Department of Water Resources to inspect or copy, or for our authorized agent named below to <br /> inspect or copy, Well Completion Reports filed pursuant to Section 13751 to make a study. <br /> In accordance with Section 13752, Information obtained from these reports shall be kept <br /> confidential and shall not be disseminated, published, or made available for inspection by the <br /> public. The information shall be used only for the purpose of conducting the study. Copies <br /> obtained shall be stamped CONFIDENTIAL and shall be kept in a restricted file accessible only to <br /> agency staff or the authorized agent for this study. <br /> Project Name: Fast' rar-d La&:y A)cry - Coun •S'r;,, l : <br /> Street Address: lqq i, 14,9r'64f4 y Way City: ,Sioeklcrq <br /> Township, Range, and Section_: Radius: -20t,6.1-Y- <br /> (Include entire study area and a map that shows the area of interest.) <br /> /}dVc,racer--1 SQri ja +V Envirf <br /> Authorized Agent Company Name Government gency Namfe 14edt14,k 'Dep}. <br /> �- Shaw P\,d _304 E. 1Ve6er Avenue <br /> Address Address <br /> -%C -}-)Y1 , 0j;,-7/S- S+oektart. CA gV202-2708 <br /> City, State, and Zip Code City, State, and Zip Code <br /> Alli Lc ocur}u Vi44oris hA,aCaY+riev <br /> Authorized Agent Name (please print) Agency Contact Name (please print) <br /> Signature: � Si nature: ' <br /> Title: Title: S6Yti Or' � , E . H- S <br /> Telephone: („ZU l ) 446-1 -/COG Tele hone: 20448 - 3454 <br /> FAX: ,2b2 q&�.-I I)& FAx: (2o9) 44 8 -....3433 <br /> Date: lot, /D , Date: } r 1 <br /> E-mail' E-mail: Vrjj4de Ar+nev @ StGehd COw► <br /> wer request-agencystudy_20060706.doc 06 July 2006 <br />