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STATE OF CALIFORNIA-THE RESOURCES AGENCY ARNOLD SCHWARZENEGGER,Governor <br /> DEPARTMENT OF WATER RESOURCES <br /> CENTRAL DISTRICT NORTHERN DISTRICT SAN JOAQUIN DISTRICT SOUTHERN DISTRICT <br /> 901 P Street 2440 Main Street 3374 E. Shields Ave Ste A7 770 Fairmont Avenue <br /> Sacramento, CA 95814 Red Bluff, CA 96080 Fresno, CA 93726 Glendale,CA 91203 <br /> (916)651-0753 (530)529-7300 (559)230-3300 (8 18)500-1645 ext.233 <br /> (916)651-0726(Fax) (530)529-7322(Fax) (559)230-3301 (Fax) (818)543-4604(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 /> Project Name: Weldon Church Property County: San Joaquin <br /> Street Address: 104 West Beverly Place City: Tracy <br /> Township, Range, and Section: Radius: 2000 f t . <br /> (Include entire study area and a map that shows the area of interest.) <br /> San Joaquin Environmental <br /> Advanced GeoEnvironmental , Inc . Health Department <br /> Authorized Agent Company Name Government Agency Name <br /> 837 Shaw Rd . 600 E . Main St . <br /> Address Address <br /> Stockton, CA 95207 Stockton, CA 95202 <br /> City, State, and Zip Code City, State, and Zip Code <br /> Becky Lee Victoria McCartney <br /> Authorized Agent Name (please print) Agency Contact Name (please print) <br /> Signature: Signature "7- <br /> Title: Staff Scientist Title: Senior R. E .H. S . <br /> Telephone: ( 2 0 9) 467-1006 Telephone: ( 209 ) 468-9852 <br /> FAX: ( 209) 467-1118 FAX: (209 ) 468-3433 <br /> Date: Date: <br /> E-mail: blee@advgeoenv.com E-mail: vmccartney@sjcehd.com <br /> wcr request-agencystudy_20060706.doc 06 July 2006 <br />