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Sep , 30 , 2002 9 39AM COh''4 EARTH TECHNOLOGIES No • 1403 P . 2/3 <br /> OTATK OF cAuV -7j2E RE90URCr <br /> DEPARTMENT OF WATER KESOURCE$ <br /> CENTRAL DISTRICT NORTHERN DISTRICT 5AN JOAQUIN DISTRICT SOUTHERN DISTRICT <br /> 32518 Street 2440 Main Street 3874 Enet Shields Avenue 770 Fairmont Avenus <br /> Sacramento,CA 96816 Red Bluff,CA 960$4 Finano,CA 93728 Glendale,CA 81203 <br /> '9116 (630 529-7300 (559)2W-4200 f818iG43.4600 <br /> ;918�IZZ-7632 <br /> 227.7900(Fnx) (5301 SU 7372(PAX) (559)230.3301(Fax) {018)543.4804(Fax) <br /> wr:LL COMPUMON REl 09T RELEASE AGREEMENT--AGENCY <br /> (Government and Regulatory Agencies and their Authorized Agents) <br /> ProjectlContracf No.----3 Y LCounty Q Ut <br /> Township, Range,and Section „sc�pr �� <br /> (Must Include antUd study area and a map that 911CIO area of inte x_) <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 bek)w to <br /> Inspect or copy,Well Completion Reports filed pursuant to scaon 13751 to(check one): <br /> Make a study,or, <br /> Perform An environmental cleanup study associated with an unauthafized release of a <br /> contaminant within a dlstenc8 Of 2 miles. <br /> In accordance with Section 13752,information obtained from theca reports shall be kept confidential <br /> and shall not be disseminated,published, or made available far 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 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 /> oc�#c�rrhTc ho[�aa <br /> n Toa r\6D, Eh vs ro vlmevl�o..� PP�1 � <br /> Authorized Agent Government or aguiatvry Agency Dai <br /> lit 1 t-C1 <br /> �" �� h <br /> Sv"�1-w q���sK" �� � '���'r <br /> Address � <br /> City, State,and Zip Geda City,State,and Z)p Code <br /> - <br /> aimature <br /> Tltle I <br /> Title l <br /> Tele b <br /> Fax oql6� <br /> Date C? = ` <br /> 6,dune 2004 <br /> f <br /> I <br /> l <br />