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STATE OF CALIFORNIA-THE RESOURCES AGENCY ARNOLD SCHWARZENEGGER Governor <br /> DEPARTMENT OF WATER RESOURCES <br /> CENTRAL DISTRICT NORTHERN DISTRICT SAN JOAQUIN DISTRICT SOUTHERN DISTRICT <br /> 901 P Street 2440 Main Street 3374 E.Shields Ave Ste A7 770 Fairmont Avenue <br /> Sacramento, CA 95814 Red Bluff, CA 96080 Fresno,CA 93726 Glendale,CA 91203 <br /> (916)651-0753 (530)529-7300 (559)230-3300 (818)500-1645 ext.233 <br /> (916)651-0726(Fax) (530)529-7322(Fax) (559)230-3301 (Fax) (818)543-4604(Fax) <br /> WELL COMPLETION REPORT RELEASE AGREEMENT—AGENCY STUDY <br /> (Government Agencies and their Authorized Agents) <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 make a study. <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 <br /> public. The information shall be used only for the purpose of conducting the study. Copies <br /> obtained shall be stamped CONFIDENTIAL and shall be kept in a restricted file accessible only to <br /> agency staff or the authorized agent for this study. <br /> Project Name: Manteca Unified School District County:San Joaquin <br /> Street Address: 660 Mikesell Avenue city: Manteca <br /> Township, Range, and Section: See map Radius: 2000 <br /> (Include entire study area and a map that shows the area of interest.) <br /> M.J. Kloberdanz & Associates San Joaquin County Environmental Health Department <br /> Authorized Agent Company Name Government Agency Name <br /> P.O. Box 576981 304 East Weber Avenue, Third Floor <br /> Address Address <br /> Modesto, CA 95357 Sockton, CA 95302-2708 <br /> City, State, and Zip Code City, State, and Zip Code <br /> Michael J. Kloberdanz Lori Duncan <br /> Authorized Agent Name (please print) Agency Contact Name (please print) <br /> Signature: * Signature: ��� JN'4-t' , CC4� <br /> Title: Owner/Consultant Title: 5' e-tAcclt 12E45 <br /> Telephone: ( 209 ) 577-8186 Telephone: ( 2-0`t ) q6 g U 3 3 <br /> FAX: ( 209 ) 577-8158 FAX: (Zvi( ) Y6 S-j 13 3 <br /> Date: October 25, 2006 Date: 10 1 Zs/v,(, <br /> E-mail: mjkloberdanz@clearwire.net E-mail [4(AKr-0, 1--,r0:D!5�C e (��,eol� <br /> wcr request-agencystudy_20060706.doc 06 July 2006 <br />