Laserfiche WebLink
I � <br /> f <br /> P <br /> STATE OF CALIFORNIA - THE NATURAL RESOURCES AGENCY EDMUND G. BROWN JR Governor <br /> DEPARTMENT OF WATER RESOURCES <br /> NORTHERN REGION NORTH CENTRAL REGION SOUTH CENTRAL REGION SOUTHERN REGION <br /> 2440 Main Street 3500 Industrial Blvd. 3374 E. Shields Ave Ste A7 770 FainnonlAvenue <br /> Red Bluff, CA 96080 West Sacramento, CA 95691 Fresno, CA 93726 Glendale, CA 91203 <br /> (530) 529-7300 (9'16).376-9612 (559) 230.3300 (8185004645 ext. 233 <br /> (530) 529.7322 (Fax) (916) 3769676 (Fat) (559) 230-3301 (Fax) (818; 543A604 (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 tiled 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: Quick N save 11a County: San Joaquin <br /> i <br /> '901 5 . el Dorado street <br /> Street Address: City: Stockton <br /> Township Range, and Section : T1 v, R6E , s°' Radius: 21000 square foot <br /> (Include entire study area and a map that shows the area of interest) <br /> Advanced oeounvixonmental Inc . San Joaquin County Environmental Health Department <br /> Authorized Agent Company Name Government Agency Name <br /> B37 Shaw Road 1868 East Hazelton Avenue <br /> Address Address <br /> Stockton , California, 95215 Stockton, californi.a , 95285 <br /> City, State, and Zip Code City , State, and Zip Code <br /> Daniel Villanueva Vicki McCartney <br /> Authorized Agent Name (please print) Agency Contact <br /> Name (please print) 1 <br /> Signature: Signature: <br /> Title: project Geologist Title: Senior Registered EnvirenInental Health spec lee <br /> Telephone: ( 209 ) 467 -1006 Telephone: ( 2o9 ) 468-9852 <br /> FAX: ( 209 ) 46 /-1118 FAX: ( 209 ) 464 - 0139 <br /> Date: 12/2d /2014 Date: [ J =l <br /> /— — <br /> E-mail: dvillanuevaeadvgeoeay . com E-mail: mnoa,-t eYanj - I,a . onm <br /> wcr_request_a0encysludg_EOi 10518.doc 18 1120 11 <br />