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10/05/2005 09:19 92546325 ATC PLEASANTON I� PAGE 02/02 <br /> ill <br /> i <br /> 'y STATE OF CALIFORNIA-THE RESOD!i^F9 AGEN Y ARNOLl1 SCHWARZENEGGER.Governor <br /> DEPARTMENT OF WATER F -SOURCES II <br /> CENTRAL DISTRICT NOF"HERN DISTRICT SAN JOAQUIN DISTRICT SOUTHERN DISTRICT <br /> 3251 S Street 244E viain Street 3374 East Shields Avenue 770 Fairmont Avenue <br /> Sacramento,CA 85816 - Red :lutf, CA 96080 Fresno,CA 83726 Glendale,CA 91203 <br /> (ate)227-7832 (530) ;29.7300 (559)2304300 (818)5434900 `. <br /> (918)227-7800(Fax) (53111 i2917322(Fax) (559)230.0301 (Fax) (816)5434604(Fax) <br /> WELL COMPI,FTION REPORT RELEASE AGREEMENT—AGENCY <br /> Authorized ns <br /> (Government ' nd Regulatory Agencies and their uthonz ge # ) <br /> (G eg ry g <br /> `�S (,r7'0SC) 320(-o . <br /> Project/Contract No. County <br /> wcy; <br /> Township, Range, and S ectir•11 I a (0 8 Redius <br /> III <br /> (Must include entire study area snot imsp that shows the area of Interest.) ao0o X4 yY.t C� I U 5 <br /> Under California Water Code lection 13752, the agency named below requests permission from <br /> Department of Water Resoun;as to inspect or copy, or for our authorized agent named below to <br /> inspect or copy,Well Comply:I ori'Reports filed pursuant to Section 13751 to(check <br /> ane): <br /> Make a study, or, <br /> Perform an environnm,:ntal cleanup study associated with an unauthorized release of a <br /> contaminant within a :Istance of 2 miles. <br /> Y � <br /> In accordance with Section 11.752, information obtained from these reports shall be kept <br /> confidential and shall not be isseminated, published, or made available for Inspection by the public <br /> without written authorization -om the owner(s)of the well(s). The information shall be used only for <br /> the purpose of conducting thstudy. Copies obtained shall be stamped CONFIDENTIAL and shall <br /> be kept in a restricted file ac ssible only to agency staff or the authorized agent. <br /> I I <br /> ✓rritiltj to VIroYlrn, ,a <br /> Authorized Agent <br /> Government r Regulatory envy Heol+k 'Dept <br /> cot p0a ;, d�- �5-42.1Co 304 E. We /�I�e»ve <br /> Address Address <br /> 7A952 <br /> 1 <br /> 02 -2'708 <br /> City, State. and Zip Code City, State, and Zip Code <br /> r ° <br /> Signature�,�� � SianatureU./,A7�?s� Ie, <br /> Title �Q�t L Title Ser i Ar <br /> �E <br /> Teleohona_ a , ' �d — Tee hone 209 =1345 <br /> FaxZS f(0 3 a 5 5 Fax zo9 !33 <br /> Date 10 . � <br /> 1 <br /> E- ail d>C11�': UI Email V GG fY1gV�QS�Ce��. Co)Yt <br /> 66 <br /> 0,+c-Q C'60 1AAe CVVI June 2001 <br />