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JUL-24-2005 15:33 D011 Group • 607 1258 P.02 <br /> STATE OF CALI E92NI HER SOuR9M Ara ENCY ARNOLp SCH_WARZENEGGER Govamor <br /> DEPARTMENT OF WATER RESOURCES <br /> CENTRAL DISTRICT NORTHERN DISTRICT SAN JOAQUIN DISTRICT SOUTHERN DISTRICT <br /> 3251 S Street 2440 Main Street 3374 East Shields Avenue 770 ralrmont Avenue <br /> Sacramento,CA 95816 Red Bluff.CA 95060 Fresno,CA 93726 Glendale,CA 91203 <br /> (916)227.7632 (580)529.7300 (559)230-3300 (818)543.4500 <br /> (916)227.7600(Fax) (590)529-7322(Fax) (559)230-3301 (Fax) (818)543-4804(F&x) <br /> WELL COMPLETION REPORT RELEASE AGREEMENT—AGENC <br /> (Government and Regulatory Agencies and their Authorized Agents D <br /> ProjecUContract No. County <br /> 441/4ewj6 37.1r424:1 ../2/. 3223 <br /> Township, Range, and Section 25. 3 C /a. r404 Radius <br /> (Must Include entire study area and a map that shows the area of interest.) <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(Check one), <br /> 7 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 <br /> confidential and shall not be disseminated, published, or made available for inspection by the public <br /> without written authorization from the owner(s) of the well(s). The information shall be used only for <br /> the purpose of conducting the Study. Copies obtained shall be stamped CONFIDENTIAL and shall <br /> be kept in a restricted file accessible only to agency staff or the authorized agent. / 1 <br /> NN�e; C�a.ad' LsirC Lo �/NY. N`Es4rnV ./�cs�3 <br /> Authorized Agent Government,&Regulatory Agency <br /> ZZ r4- <br /> Address <br /> SAddress Address <br /> Z4 95202-- <br /> City, Stalle, and Zip CodA t City, State, and Zi Code <br /> �rA kM� <br /> Signature Si natured 6 <br /> Title Title <br /> Telephone (lar 402 ' P-327 Telephonnekw) <br /> O <br /> Fax (?2_V) G87 - r2S8 Fax <br /> Date 7'j'/I °'a Date <br /> E-mail net-ae%k. c awl P-mail /ur//✓�ie/> C6wb• Owl <br /> 6 June 2001 <br />