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From:SanjoCo-Oakland Office 510633&9119 To:Rebecca SetliN date:411712002 Time:1:42:26 PM Page 2 of 3 <br /> CENTRAL DISTRICT �%WID:227-7600 APR 16 'U2 15 :00 140 .404 P.01 <br /> RTATE Or CAMFORMiA• ME R6111GURCIES AdENCY OPAY OAVIS.Oowrnor <br /> DEPARTMENT OF WATER RESOURCES <br /> CENTRAL DISTRICT NORTHERN DISTRICT SAN JOAQUIN DISTRICT SOUTHERN DISTRICT <br /> 3251 S Street 2440 Main Street 3374 Easl Shleldt:Avenue 770 Fairmont Avenue <br /> Sacramento,CA 85816 Red Bluff,CA 96080 Fresno.CA 93728 Glendale,CA 91203 <br /> (916)227.7032 (530)629.7300 (659)230-3340 (8181)54340M <br /> (818)227.7000(Fax) (630)529.7322(Fax) (669)2303301(Fax) (910)54346U(FW <br /> VVELL COMPLETION REPORT RELEASE AGREEMENT AGENCY <br /> (Government and Regulatory Agencies and their Authorized Agents) <br /> Projeot/Contract No. ?i,"b w•lt-r*Sad .'2. County aye►, <br /> Township, Range,and Sectlon S V7 Z1-Z142& Radius <br /> (Must Include entire study Brea end a map that shows the area of lnlar .) <br /> Under California Water Code Seotion 13752,the agency named below requests psrmlasion from <br /> Department of Water Resources to Inspect or copy,or for our authorized anent named below to <br /> Inspect or copy,Well Completion Reports filed pursuant to Section 13751 to(check ane): <br /> Make a study,or, <br /> ® Perform an environmental cleanup study associated with an unauthorized release of a <br /> contaminantwithin a distance of 2 miles. <br /> In accordance with Section 13752,Information obtained from these reports shall be kept cpnfldentlal <br /> and shall not be disseminated, published,or made available for inspection by the public wlthout <br /> written authorization from the ownor(s)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 shall be <br /> kept In a restricted file acxe6sible only to agency staff or the authorized agent. <br /> C,fj 4t t V1 lj%%1f k <br /> Authorized Agent 4�0 �r•�c Government or R gulatory Agency -� <br /> rr2� �►���.�� A�S.�«,rr3 c,, <br /> Address Address <br /> c <br /> "r 1 (5 3�b <br /> City,State, nd Zip Code <br /> City,State,and Zip Code <br /> PrkSlonat - ^"' i u e <br /> itl sTf��+.. a �"rii•iEr�� Title C 1&' ty <br /> Telephone :50 -' Z <br /> Fax p--1 i Fax r.!�e2)� 35F3 - <br /> E-mailDate tjf <br /> U S Co •s- E-mail S ( ick CDW` <br /> 6 June 2001 } <br /> i <br />