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1]i/11/2004 THU 12:43 FAX 916 679 2422 LIRS SACRAMENTO FINANCE R002/007 <br /> STATE.OF CAUFORM A-THE RESOURCES A©ENCY _ GRAY DAVIS,Governor <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 95816 Red Bluff,CA 96080 Fresno,CA 83726 Glendale,CA 81203 <br /> (916)227-7632 (530)528.7300 (659)230-3340 (818)1543.4600 <br /> (916)227-7E00(Fax) (530)529-7322(Fax) (558)230-3391 (Fax) (818)543.4NM{Fax) <br /> WELL COMPLETION REPORT RELEASE AGREEMENT--AGENCY <br /> (Government and Regulatory Agencies and their Authorized Agents) <br /> �k t <br /> Project/Contract No. 0 4�o„t z. . i31t.1.34 2 s Troounty5C1_V-1 i'A <br /> Township, Range, and Section 'r S E S l q ? Radius_:;_ 0 <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 /> 154 Make a study, or, <br /> ElPerform 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 confidential <br /> and shall not be disseminated, published, or made available for inspection by the public without <br /> written authorization from the owner($)of the Well(s). The Information shall be used only for the <br /> purpose of conducting the study. Copies obtained shall be stamped CONFIDENTIAL and sliall be <br /> kept in a restricted file accessible only to agency staff or the authorized agent. <br /> Authorized Agent Government or Regulatory Agency <br /> zgao &4At .. .3cp 3o 4 F, .L bee, <br /> Address Address <br /> S 4015-Z0"L_ <br /> City, State,and Zip Code City, State, and Zip Code p <br /> 81 naturenature <br /> r� <br /> Title <br /> Telephone (fl(-)(-) 6-19 - Tele hone - 3YZ- <br /> Fax (9A ���- �_� d � Fax (2bS) q-648 <br /> Date It r l 4 D to l l <br /> E-mail �An;tC� -VaJ UR$COCD •c4D-" E-mail Al < a`6CtA--1.Lo"0% <br /> 6 June 2001 <br />