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NOV-18-2008 04 : 10 PM PALMER, CEG 408 267 7396 P. 03 <br /> ATA_7E GF CALIFORNIA.-1AGENCY q,130911-9 ArdIdWAMNEGGER,GoveM2r <br /> DEPARTMENT OF WATER RESOURCES <br /> CENTRAL DISTRICT NORTHERN DISTRICT SAN JOAQUIN DISTRICT SOUTHERN DISTRICT <br /> 901 P Street 2440 Mein Street 3374 E,Shields Ave Ste A7 770 Fairmont Avenue <br /> Sacramento,CA 96614 Red Bluff,CA 98060 Fresno,CA 93728 Glendale,CA 91203 <br /> (918)651.0763 (530)529-7300 (889)230-3300 (816)600-1648 ext.233 <br /> (9 16)661-0720(Fax) (530)829-7322(Fax) (559)2303301(Fax) (818)643-4404(Fox) <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 /> Pro act Name: � d- T_ru W c f County: 2)okvt �r..ar, Ui�r► <br /> Street Address City: <br /> Township, Range, and Section: "T2.9 R s r ,Sec �'�( 10 Radius: 7-c e. �eA t <br /> (include entire study area and a map that shows the area of interest) <br /> W �+ n.► P.iil-.+� Sa-v w cto 914c.. 30 �"ua��.,� , t�tiy, HW J t A#1 <br /> Autho zed Agent Company Name Government A'ency Namer <br /> Z 6` P e.s Goi d e r e Avy-d "t — _G o o f •tM o, t t, <br /> Address Address <br /> City, State(, end Zip Code Cl, State, and Zip Code <br /> Us:IsPod"t, 4o%,wr) Y-Fm t/ St4,Our-, DuA) 1anJ <br /> Authorized Agent Name (plIelse print) Agency Contact Name(please print) <br /> Signature: A-I1444 ,10ZA w) fi& s Signature: (pj,,Z <br /> Title: 11�.,d t o t d�o i'b f Title: 2 E (� S <br /> -— Pilnrcn - <br /> Telephone; (`f D$) -� 7�5 Z.3 b Telephone: Q o I L( 6 cG d 3 3 FAX: (`f O$) 2-Cc 7- 73 67 FAX: (_;?c0t)_ Y�_c6 _ �t 3 <br /> Date: Nptl, it ZD d Date: I t <br /> E-mail- C M PA Cj Ol C1 010 1,a E-mail: tnca <br /> wcr roqusot-oq*nqrtudy 20odo708.doa 06 July 2006 <br />