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Mar. 14. 2006 10:46AM Adv-,raced GeoEnvironmental No. 4226 P. 2 <br /> ,*we %%W <br /> NATE OF CALIFORNIA-THE RESOURCES AGENCY _ _ARNOLD SCHWARZENEGGER,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 95818 Red Bluff,CA 960BO Fresno,CA 93726 Glendale,CA 81203 <br /> (916)227-7632 (530)529.7300 (559)2303300 (81 B)543-4600 <br /> (91 B)227-7600(Fax) (530)529-7322(Fax) (559)230-3301 (Fax) (81 B)543-4604(Fax) <br /> WELL COMPLETION REPORT RELEASE AGREEMENT--AGENCY <br /> (Government and Regulatory Agencies and their Authorized Agents) <br /> Project/Contract No. 1A -09SL I 3ga,;n County <br /> Township, Lange, and Section Radius <br /> 11,-, Z r� <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 /> Ll Make a study, or, <br /> - i perform an environmental cleanup study associated with an unauthorized release of a <br /> I 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 /> �ICc.K Joa�vcik CoJw"� <br /> Authorized Agent Government or Regulatory Agency <br /> 83 S w 3 ay e..d /,e <br /> Address Address <br /> City, State, and Zip Code City, State, and Zip Code <br /> Signatljr2 Sianature-- <br /> Title Title <br /> Telephone_ (zb� ) y�7 r b�� _ Telephone ( 2°g) 6 <br /> Fax (2eq j_qj�,7 -- 1)1 S Fax (91,_9 ) -,14 ` :5r�33 <br /> Date 03-- I L4-06, Date 1��A4a Grd0� <br /> E-mail E-mail ��eHr/���o�� f C �• Coif <br /> 6 June 2001 <br />