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APR-07-2006 08,18 CONnOR EARTH TECH 209 532 0773 P.02 <br /> -THE R AGENCY ARNOLD S EGGER <br /> DEPARTMENT OF WATER RESOURCES <br /> CENTRAL DISTRICT NORTHERN DISTRICT SAN JOAQUIN DISTRICT SOUTHERN DISTRICT <br /> 3251 S Street 2440 Main Straat 3374 East Shields Avenue 770 Fairmont Avenue <br /> Sacramento,CA 95616 Red Bluff,CA 96080 Fresno.CA 93728 Glendale,CA 91203 <br /> (916)227-7032 (530)529-7300 (.559)230-3300 (818)543-4600 <br /> (916)2274600(Fax) (W)529-7322(Fax) (559)230.3301(Fax) (810)54346(M(Fax) <br /> WELL COMPLETION REPORT RELEASE AGREEMENT--AGENCY <br /> (Government and Regulatory Agencies and their Authorized Agents) <br /> Project/Contract No1%- tl V aa. yl neounty <br /> Township, Range, and Section-F1 M , I\� .J�C• c �oC =Radius <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 /> E] 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 /> �T Sart Joalvin Count <br /> `Jo"b op- eri i 1sc.NN0 <br /> Authorized Agent -lrtr . Government or Regulatory Agency <br /> c,71663 BQAtj „LANG 3 0 4 E . We,�or Aver-v e <br /> Address Address <br /> SOuo RS73-70 S+oe-k+-avi . CA g s 2 0 z <br /> City. State,and Zip Code City, State, and Zip 6ode <br /> 51 n Si nature <br /> Title Title e n t o r <br /> Telephone t U ,�,� -tea a_�, Telephone .(W) <br /> Fax Fax (2a9)_ 46 3x-33 - <br /> Date Date A V r:_1.. 7, 2-0 0 L <br /> E-mail <br /> S June 2001 <br /> TOTAL P.02 <br />