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07!06/2005 26:23 5306766085 STRATUS NO CALIF PAGE 02102 <br /> a <br /> STATE OF CALIFORNIA-THE RE$ NY ARNOLD SCffiYAMENEGgE&Ga mor <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 95616 Red Bluff,CA 96080 Fresno,CA 93726 Glendale,CA 91203 <br /> (916)227.7632 (530)529-7300 (559)230300 <br /> (916)227-7600(Fax) (530)529-7322(Fax) (559)230-3301 Fax (818)543-460D <br /> (Fax) (816)-543.4604(Fax) <br /> WELL COMPLETION REPORT RELEASE AGREEMENT--AGENCY <br /> (Government and Regulatory Agencies and their Authorized Agents) <br /> Project/Contract No. S�`00 6115- County S41� <br /> 2Ave_Co L- Lw,�. y <br /> r <br /> Township, Range, and Section _T 3 1 I We Y 1 Radius / 1�+� <br /> N 38° - 9r7 td rZl' 18, 380 ` <br /> (Must include entire study area and a map 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 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 <br /> confidential and shall not be disseminated, published, or made available for inspection by the public <br /> without written authorization from the owner(s) 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 /> Ty r �e1 ti/►�ov�nA 8`yks+-� �t C. S Qom` 5't� �✓ 6 <br /> Authorized Agent Governmen or Regulatory Agency <br /> 53-50 Ca.wt v-,r rvt r_ S"a 3,5 q Jam— C cr-Z r <br /> Address Address <br /> City, State, and Zip C_odg City, State, and Zip Code <br /> Si nature Signature <br /> Title ems " Lh5 osr Title s <br /> Telephone 5$ G &00 Telephone ( ? Y t�8" qq _ <br /> Fax &0,0 Fax ( _l `j � `7 ) ) <br /> .lv 711 1 �D 1 <br /> Date— �� �� Date zcry <br /> E-mail Smear ,��.ivSE ,�_�e� E-mail A-��a�� �JG FH`J�• �"a►,... <br /> 6 June 2001 <br />