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MAY.23.2006 2:13PM APEX ENVIROTECH,INC. NO.001 P.c <br /> $TATE OF CALIFORNIA-THE RESOURCES AGENCY ARNOLD SCHWARZI_NEGGER,Governor <br /> DEPARTMENT OF WATER RESOURCES <br /> CENTRAL DISTRICT (NORTHERN DISTRICT SAN JOAQUIN DISTRICT SOUTHERN DISTRICT <br /> 3251 S Street 2440 Main Street 3374 East Shields Avenue 770 Fairmont Avenue <br /> Sacramento,CA 95816 Red Stuff,CA 96080 Fresno,CA 93726 Glendale,CA 91203 <br /> (916)227-7632 (530)5201-7300 (559)230-3300 (618)543-4600 <br /> (916)227-7800(Fax) (530)52S-7322(Fax) (559)230-3301(Fac) (818)543-4604(Fax) <br /> WELL COMPLETION REPORT RELEASE AGREEMENT-AGENCY <br /> (Government and Regulatory Agencies and their Authorized Agents) <br /> Project/Contract No._.____ County <br /> Township, Range, and Section 1�00-5 Radius <br /> (Must irclude entire study area aro a rrap that shows the area of interest) <br /> Under California Water Code Section 13752, the agency named below requests permission from <br /> Department of Water Resources to inspect orcopy, orfor our authorized agent reamed below to <br /> inspect or copy, Well Completion Reports filed pursuant to Section 13751 to(check one): <br /> Make a study, or, <br /> ("x� Perform an environmental cleanup study associated with an unauthorized release of:� <br /> J Contaminant within a distance of 2 miles. <br /> In accordance with Section 13752, information obtained froth these reports snail be kept <br /> confidential and shall not be disseminated, published,or made available for inspection by the public <br /> without written authorization from the owners) of the well(s). The information shall be used only for <br /> the purpose of conducting the study. Copies obtained shall be stamped CONFIDENTIAL,and shall <br /> be kept in a restricted file accessible only to agency staff or the authorized agent, <br /> ,kkf,. Nur t-HCr�D 2�oF5 <br /> Authorized Agent Government or Regulatory Agency <br /> _11.P"J4 k�M 304 F--xA3ft K <br /> Address Address <br /> GUt„D f-we.'i aft 95LOIQ SFbct4' I (!A ct-52.01 <br /> City, State, and Zip Code City, State, and Zip Code <br /> Si natire Si nature ��� <br /> ih CCs�i�l �U"F7`/S f <br /> Title .S7AFF C 6D 1.19G j r;�j" T Title e7` <br /> Telephone (9t(o )a,,-p,.4 Teleohone <br /> ) <br /> Fax (Ii(e ) 85i-014 Fax (2o9 ) 44-.pi3? — <br /> Date 1 _3•ol" Date <br /> S���LL�i ° � '.+�� /� ✓I��t' 1y1 S�Ce�7�J< <Dh'( <br /> E-mail r. a C E-mail /7�/t° <br /> 6 Jurle 2001 <br />