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05/25/2004 11:19 209-577;..8158 MJ KILOBERDANZ PAGE 02 <br /> r ! <br /> STATE U. IFORNU4-THE&EMyUQ MENQY GRAY DAVIS. r <br /> DEPARTMENT OF WATER RESOURCES <br /> CENTRAL DISTRICT NORTHERN DISTRICT SAN IOAQUIN DISTRICT SOUTHERN DISTRICT _ <br /> 3251 S Street 2440 Main Street 3374 East Shields Avenue 770 Faltmont Avenue <br /> Sacramento,GA 95816 Red Bluff, CA 96080 Fres o,CA 83726 Glendale,CA 91203 <br /> (918)227-7632 (630)529-7300 (559) 30.9300 (818)5434600 <br /> (916)227-7600(FaX) (530)529-7322(F4x) (559) 303301 (Fax) (818)5434604(Fax) <br /> WELL COMPLETION REPORT REL 5E AGREEMENT--AGENCY <br /> (Government and Regulatory Agencise and their Authorized Agents) <br /> Project/Contract No.24100 S. Lammers Rd. in Trac County San Joaquin - <br /> Township, Range, and Section Sec. 30, T, 2S., R. 512. Radius 2000 feet <br /> (Must include entire study area and a map that shows the area of i tersest.) <br /> Under California Water Code Section 13752, the agendy named below requests permission from <br /> Department of Water Resources to inspect or copy, or or our authorized agent named below to <br /> inspect or copy, Well Completion Reports lined pursuant to Section 13751 to(check one): <br /> FV7( Make a study,or, <br /> EPerform an environmental cleanup study assoc ated 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 owners)of the well(s). The information shall be used only for the <br /> purpose of conducting the study. Copies obtained sha 1 be stamped CONFIDENTIAL and shall be <br /> kept in a restricted file accessible only to agency staff or the authorized agent. <br /> M.J. Kloberdanz & Associates San Joa uin County DEH <br /> Authorized Agent Gov mment or Regulatory Agency <br /> P.O. Box 576951 304. E. Weber Ave., Third Floor <br /> Address Address <br /> Modesto, CA 95357 Stockton, Califomia 95202 <br /> City, State, and Zip Code City, State, and Zip Cotte <br /> Signature Si n tura <br /> Title Consultant -5-e n car, 2.6:74 S <br /> Telephone las 577-8185 Telephone (LEf) <br /> FaX 209 577-8159 Fax <br /> Date 5-25-04 <br /> E-mail majekaa sonnet.com E-mail . <br /> 6 June 2001 <br />