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07 / 14 / 2004 14ED 13 : 06 FAX 916 679 2422 URS SACRAMENTO FINANCE U002 / 002 <br /> STATE OF CALIFORNIA - THE RESOURCES AGENCY _ ORsY DAY15, Gnv or <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 95696 Red Bluff, CA 96080 Fresno, CA 93726 Glendale, CA 91203 <br /> (916) 227-71332 (530) 529-7300 (559) 2303300 (61e) 543-0600 <br /> (916) 227.7600(Fax) (530) 529.7322 (Fax) (559) 230.3301 (Fu) (818) 5434604 (Fax) <br /> WELL COMPLETION REPORT IRELEASE AGREEMENT—AGENCY <br /> (Government <br /> and Regulatory Agencies and their Authorized Agents) <br /> Project/Contract No, A L& �i'��ieln S County So^ <br /> Township, Range, and Section I Z f`4 R (o 5 i�- + S 1 b _Radius 800 leek <br /> (Must include entire study area and a map that sho the area of nterest) <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 (check one): <br /> .Make a study, or, <br /> Perform an environmental cleanup study associated with an unauthorized release of a <br /> contaminant within a distance of 2 miles. <br /> In accordance with Section 13752, information obtained from these reports 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 shall 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 /> ( � <br /> Authorized Agent Government or Regulatory Agency <br /> 2 �o 040 �� � ©w� Soy • t .)EV�� i2 /ktl� <br /> Address Address <br /> S1 1 ,41 S T-Oc ICNC/\) C A 9 5 zoZ <br /> City, State, and Zip C c e City, State, and zip Code <br /> Signature - Si nature <br /> Title a t ,,.. _ tclog o S� Tie SCiVlp2t�� �r� S <br /> Telephone ( `% jd_) 67 _ 22 (0 Telephone ) / 6 �D33 <br /> Fax ( R16 ) (0 2-- q'2- qC) 0 Fax c>V7 y6fs 3y3 3 <br /> Date ( �/b Date <br /> E-mail E-mail ullcct + ee c� <br /> 6 June 2001 <br />