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08/18/2004 FLED 11:29 FAX 916 6-9 2422 URS SACRAMENTO FINANCE <br /> �ioa2�oa r <br /> STATE OF EESAENI:Y ! Y DAMS 62]mo <br /> DEPARTMENT OF WATER RESOURCES <br /> CENTRAL DISTRICT NORTHERN DISTRICT SAN JOAQUIN DIMICT SOUTHERN DISTRICT <br /> 32$18 Street 2440 Main Street 3374 East Shields Avenue 770 Faimont Avenue <br /> Sacramento,CA 95816 Red Bluff,CA 96080 Fie n%CA 93728 Glendale,CA, 91203 <br /> (OW 2r7-783Z (baa)62 7300 (599)2SMSDO (ala)543-4eeo <br /> (948)2x7-7t300(F9x) (5M 529'7922(Fa (659)23U 3301(Fax) (819)549-x604(Falx) <br /> WELL COMPLETION REPORT F LE E AGREEMENT--AGENCY <br /> (Government and Regulatory Agencies and their Authorized Agents) <br /> II-+Fee m mfr '~ ' <br /> ProjectlContract No. �`3 vt(.k c County r a j <br /> ptfeca <br /> Township, Flange,and Section h1 K60 C 5w,{cw-s Q.-K: vL. R2dius__Isl-� <br /> (Must include emir:study area and a rnap that shoft the ares of InIerest.) i <br /> Under California Water Code Section 13762,the iagency 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 fled pursuant to Section 13751 to(check one): <br /> Make a study,or, <br /> s Perform an environmental cleanup study associated with an unauthorized release of a <br /> EJ 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(s)of the well(4 The information shall be used only fnr the <br /> purpose of conducting the study. Copies obtained'shall be stamped CONFIDENTIAL and shall be' <br /> kept in a restricted file accessible only to agency staff or the authorized agent. <br /> !: <br /> Authortwd Agent Government or Regulatory Age <br /> 3 4 Ace . 3 <br /> AddressAddress <br /> CA _ 252-OL <br /> City,State, and Zip Code, City, State,and Zip Code <br /> Si ria ra Si natu - <br /> TWe <br /> Telen one Telephony�, �1_} (P 1 <br /> Fax b - a a Fex 'o-- 3 AL3 3 — <br /> Date nate, — <br /> E-mail E-mail Lku f , C Q�tld L v • <br /> 6 June 2001 <br />