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NOV-18-2008 04 : 10 PM PALMER, CEG 408 267 7396 P. 02 <br /> 1 '%� `rl <br /> DEPARTMENT OF WATER RESOURCES <br /> N rRA�.DISTRICT NORTHERN DISTRICT SAN JOAQUIN DISTRICT SOUTHERN DISTRICT <br /> CE <br /> CEP Street 2440 Main Street 3374 E.Shields Ave Ste A7 770 Fairmont Avenue <br /> 901 <br /> Sacramento,CA 95814 Fled Bluff,CA 98080 Fresno,CA 93726 Glendale,CA 91203 <br /> (8113)851-0753 (530)529-7300 (559)230-3300 (816)600.1846 ext.233 <br /> (916)6510726(Fax) (530)520.7322(Fax) (559)230-3301(Fax) (818)543 804(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 /> Pp'ect Name: Sm County19 IS�, 7 <br /> 61Wkl <br /> StreetAddress: 99 � .��o sCity. <br /> Township, Ran a and Section: S - zce- 2 1 r Zj Radius: 0-4-0o-� <br /> (include entire study area and a map that shows the area of interest.) <br /> W h ;r& S 01•ec. -%w dOt j,.nUot fit y En v. ked f4 ��►�/� <br /> Authortzed Agent Company Name Government Agency Nfame <br /> 7-3 9 A e s Cade r v►tn�. L o <br /> Address Address <br /> �C `��3d Sig cfc. C /•4- 5 2oZ <br /> City, Statifi, and Zip Code City, State, and Zip Code <br /> �C.Hr�s A�Fwlct, .-wvi I !a~,tic�i Se.+�, Ste, f-L c <br /> Authorized Agent Name (please print) Agency Contact Name (please print) <br /> Signature. • N w. Signature: paA <br /> Title: a tl f'G 's Title: <br /> Telephone: Telephone:„(20'� Y�_� 3 � <br /> FAX: ( 4E) UP 7- 7 3 c16 _ FAX: v� <br /> Date: ry vvv. I d Sr Date: I t b l C,1 40_ <br /> E-mail; CMPiRGCTG HG eold l.ca>a., E:mail.: �luKc <br /> o�K@ � <br /> wcr r"u4t1-89encystudy_200t30706.d00 08 July 2008 <br />