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04 / 17 / 03 THU 09 : 12 FAX 916 67^2900 ITS - 0002 <br /> SSE OF CALIFORNIA THE RESOURCES AGENCY <br /> DEPARTMENT OF WATER RESOURCES PRAYrIAws• Guwmz <br /> CENTRAL DISTRICT NORTHERN DISTRICT SAN JOggUIN DISTRICT <br /> 3251 S Street 2440 Main street SAN East Shields Avenue 'OUT"HERN DISTRICT <br /> Sacramento, CA 95816 Red Bluff, CA 9606o Fresno, CA 93726 770 Fairmont Avenue <br /> (916) 227-7632 (530) 529-7300 Glendel9, CA 91203 <br /> (916) 227-76a0(Fax) (530) 5294322 (Fax) (559) 230.33010 (Fax) (816) E<4600 <br /> (818) ,5"604 (Fax) <br /> WELL COMPLETION (REPORT RELEASE AGREEMENT.AGENCY <br /> (Government and Regulatory Agencies and theirAuthari;red Agents) <br /> Project/Contract No. AJC© inf <br /> Couni.y ��L 5G 4a (n,riit <br /> Township, e, da Al (� G F � �, r� 1L <br /> P g and Section �''� <br /> (Must include entire study area and a map that shows ma area of interest.) "'""�ftad'lus d� 000 <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 :)gent named below to <br /> inspect or copy, Well Completion Reports filed pursuant to Section 13751 to (check one): <br /> Make a study, or, D <br /> Perform an environmental cleanup study associated with an unauthorized r+? se <br /> contaminant within a distance of 2 miles. ,�$ <br /> In accordance with Section 13752, information obtained from these reporto shall be kept confidential <br /> and shall not be disseminated, published, or made available for inspection by the public without <br /> written authorization from the owner(s) of the well(s). The information s gall be used only for the <br /> purpose of conducting the study. Copies obtained shall be stamped CONFIDENTIAL and shall be <br /> kept in a restricted file accessible only to agency staff or the authorized agent. <br /> kk <br /> Authorized Agent Govemment o Regulatory Agcy <br /> Address Address <br /> 94MMf 3y0c.� L_Cry 0 '� <br /> City, state, and Code City, State, and Zip Ccde <br /> Si natur Si nature <br /> Title CO �77 <br /> TiHe <br /> Teleohone 7g " <br /> Telephon�ey (�I//1 7��'• �50 <br /> Fax G7,9 � C) Fax �!) 178 3 33 <br /> � <br /> Date O 3 Date tz 0 3 <br /> E-mail ldtry �/ bJ /C° �lfE,a , _mail �fiAj{.Gu W<1cca- [LY?y( <br /> 6 June 2001 <br />