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NOU-20-2001 17:12 CAMBRIA P.02iO3 <br /> 9727E er:rrLIFAR�fA-IMA RESG RGES AnTt rte,_,_... CRAY-DAM.22 Ma_ <br /> DEPARTMENT OF WATER RESOURCES <br /> CENTRAL DISTRICT NORTHERN DISTRICT SAN JOAQUIN DISTRICT SOtT TERN DISTRICT <br /> 32518 Street 2440 Main Siaot 3374 East Shialos Avenue 770 Falrrnont Avenue <br /> Sacramento.CA 95810 Red glint,CA 96080 Fresno,CA 93726 Glendale,CA 91203 <br /> (916)227-7632 (530 529•i300 (sib)5434wo <br /> (916)227-7900(Fox) (630)520-7322(FO4 (55559)22.330-M01(Par) (818)s4meu(rax) <br /> WELL COMPLETION REPORT RELEAS9 AGREEMENT-AGENCY <br /> (Govemment and Regulatory Agencies and their Authorized Agents) <br /> Pro)ect/Contract No. 8P-1101 ,County sen. --ro—U41 A <br /> Township, Range.and Section -rZ A/ R hew IS H Radius �gl mile <br /> (Moet Include angra otudy area end a reap IhA shows the area of Into rest.) <br /> Srtrey ��e0. i4cludes- T2MIR 64 - left; 'rZNla61I i TZA-111tbff- i1 C,D,E;F�6,r+^p ' }�AjS�F1Gj14� <br /> Under California Water Code Section 13752;the agency named below requests p4rmisslon from 14)< iv G)R <br /> Dopertment of Water Resources to inspect or copy.or for our euthoftsd went named below to <br /> inspect or copy,Well Completion Reports fled pursuant to Section 13751 to(cn$OK one) <br /> 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 confidential <br /> and shall not be disseminated, published, or mads available for inspection by the public without <br /> written authorization from the owners)of the well(s). The Information shall be used only for the <br /> purpose of oondt cting the study. Copies obtained shall be stamped CONFIDENTIAL and shall be <br /> kept In a restricted elle accessible only to agency staff or the authorized agent. <br /> /' l t <br /> 4-gVvl bf10c. ����!/Y+QV4W�L� S01['b►�LLiryl�.� , �'�L � 40 �L'[.� <br /> Authorized Agent Governrh6nt dclRegulatory Agency <br /> 1:�-- — 12b Vj <br /> .—_.(62 62- <br /> ., - <br /> Address Address <br /> City,State, and zip Code City,State,and Zip Code <br /> SfanafurA,._ ?:` SICIrtaturraEll <br /> TiVe <br /> y g <br /> Telephone 157o 11 -.-70 1TelerhoaP t W] <br /> Elm' {5111 14% r"7-95 Pax --�1 <br /> Vit - _. . <br /> DateDate- <br /> In-mail SGIw,S�. Cambria-eviV, edrA Email <br /> 6 June 2001 <br /> TOTAL P.01 <br />