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07/08/2005 15:05 FAX 9166792900 URS-SACRAMENTO-GO 002/003 <br /> i <br /> STATE OF CALE9jk tIA-THE RESOURCES APRk!cy GRAY bAy1S.t3oremor <br /> DEPARTMENT OF WATER RESOURCES <br /> CENTRAL DISI KIGI NQRTHL-RN(M>fKIuf SAN JOAQUIN DISTRICT SOUTHERN DISTRICT <br /> 32SI 6 Street 2440 Main Street 3374 East Shields Avenue 770 Fairmont Avenue <br /> Sacramento,CA 95816 Red 81uff.CA 96080 Fresno, CA 93728 <br /> (916)227-7632 (530)52l}7300 Glendale, 9120$ <br /> (559J 230-3300 {818}649.460 00 <br /> (916)227-7600(Fax) (530)529-7322 Brix) ('wW)230-3301(F-") (.9111)543 46p4(Fax) <br /> WELL.COMPLETION REPORT RELEASE AGREEMENT-AGENCY <br /> (Government and Regulatory Agencies and their Authorized Agents) <br /> Project/Contract No. 1t1 ? 3']S <br /> 1 RRG.{ gwcj- County GA,, daG[0jr3 <br /> Township, Range,and Section 1 2 s1 +5 E . Sa�'- *; Radius 9-001) <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 authored agent named below to <br /> inspect or copy, Well Completion Reports filed ptlrsi,tant to Section 13751 to (check one).- <br /> Make a study, or, <br /> I HertOF711 an environmental Cieanulp study associated with an unAtithnn7farf rwlgaSP rtf?� <br /> I r.nntnminant wifhrn a rliGtnne,P of 9 mi"s <br /> In accordance with Section 13752, infomt aUon obl ained froru these reports shall be kept confidential <br /> and shall not be disseminated, published, or made available for inspection by the public without <br /> written author¢ation from the owners)of the well(s). The information shall be used only for the <br /> purpose of conducting the study. Copies obtained 6hall be stamped CONFIDENTIAL and shall be <br /> kept in a restricted file accessible only to agency staff nr.the authOrixed ag?nt. <br /> �� •f4 Rt-t rJ k.Na i_.L <br /> 1 <br /> L)(4G C.raA-Na P.-C-40 r'j y DAOU,g) <br /> Aut"YI-W,"}^y3 ,`, uuv,�rnrnen or Regulatory A et1Cy <br /> Address Address <br /> CA, q s$'s �tx -ofd CA '0-C,rZ <br /> City, State,and Zip Carie City, State, and Zip Code <br /> Signature '��R� Si±anat� �tiL.�•�-� _ <br /> Title. r�l.o Crr�S'1 ri+I� � • � �'� • j <br /> T'ei ,:�;tb 6 ' u / Telephone ���1 ' Y 2 <br /> Fax C1116) Fax 3Y 33 <br /> Date -9k�F' o '� <br /> F-mail �•t �aaul.. c _.: 1,. I f I E L .1 . T <br /> 6 June 2001 <br />