Laserfiche WebLink
STATE OF CALIFORNIA-THE RESOURCES AGENCY ARNOLD SCHWARZENEGGER Governor <br /> DEPARTMENT OF WATER RESOURCES <br /> CENTRAL DISTRICT NORTHERN DISTRICT SAN JOAQUIN DISTRICT SOUTHERN DISTRICT <br /> 901 P Street 2440 Main Street 3374 E. Shields Ave Ste A7 770 Fairmont Avenue <br /> Sacramento, CA 95814 Red Bluff, CA 96080 Fresno, CA 93726 Glendale,CA 91203 <br /> (916)651-0753 (530)529-7300 (559)230-3300 (818)500-1645 ext.233 <br /> (916)651-0726(Fax) (530)529-7322(Fax) (559)230-3301 (Fax) (818)543-4604(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 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 /> Project Name: <br /> Pair 1( c�NtS H�`v``h�2 r L ✓�� County: �ah �d�,k u,1, <br /> Street Address: rlAMyh4r L4k,( City: <br /> T)A/, (vL ,S"C. 1-7, tg, 11, X" <br /> Township, Range, and Section: -(iv k SIE SES Sed' +I-, 131 ,14 Radius: �-OoO <br /> (Include entire study area and a map that shows the area of interest.) <br /> S�rg ��s Egvlw�" wah1-011i rhe. Say, a0ci, <br /> Authorized Agent Company Name Government Ag ncy Name <br /> .V3 6 COLw,t"" N'A - b" COO L , IAw, <br /> Address Address <br /> CctV'1Qrdn �a�fC , t3 ��2, S�oc,���,� I �� �5n-DZ- <br /> City, State, and Zi/p Code City, State, and Zip Code <br /> �t� t )u�+�t IhA V i G+Or i n ..MG CaY-+rt et/ <br /> Authorized Agent Name (please print) Agency Contact Name (please print) <br /> Sign ature: CG �7 Signature: <br /> Title: G-eolo �;4 Title: 8enjnrReql*Sjered Eny,ronme , I <br /> ` H ec►l-f-h est- <br /> Telephone: ( 910 ) -7 6- ),o(D`l Telephone:,( 2.1.9) 4 4.8 —q_'87! <br /> FAX: (s10) 06- 6 do y FAX: ( 209 ) -+6.8 — 34-33 <br /> Date: P VW Date: $ I I I D S ` <br /> E-mail: 0 d U d d 'h� � �����vS 10 C,�Rr E-mail: W rn r e <br /> wcr request-ageneystudy_20060706.doc 06 July 2006 <br />