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STATE OF CALIFORNIA•THE R OURCES AGENCY <br /> 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 91203818 500-1645 ext.233 <br /> (916)651-0726(Fax) (530)) <br /> (916)651-0753 ( 529-73202(Fax) (559)230-3301(Fax) (818)543-4604(Fax) <br /> WELL COMP ETION REPORT RELEASE AGREEMENT—AGENCY STUDY <br /> (i overnment Agencies and their Authorized Agents) <br /> Under California Water C ode 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 Coi npletion Reports filed pursuant to Section 13751 to make a study. <br /> In accordance with Secti n 13752, information obtained from these reports shall be kept <br /> confidential and shall no be disseminated, published, or made available for inspection by the <br /> public. The information hall be used only for the purpose of conducting the study. Copies <br /> obtained shall be stampi d CONFIDENTIAL and shall be kept in a restricted file accessible only to <br /> agency staff or the auth rized agent for this study. <br /> Pro ect Name: Lope 1 Property & Comfort Air county: San Joaquin <br /> /(eo I and 14.07 7urrip ke. 'Rd. City Stockton <br /> Street Address: 222 <br /> Township, Range, and Action: T1 N R6E west Of Section 10) Radius: 2000 feet <br /> (Include entire study area and a map that shows the area of interest.) <br /> Advanced GeoEnvironrT ental, Inc. Government Agency Environmental Health Department <br /> Authorized Agent Comp ny Name <br /> ame <br /> 837 Shaw Road 600 F__. Main <br /> Strout <br /> Address Address <br /> Stockton, CA, 95215 Stockton CA 95202 <br /> City, State, and Zip Cod City, State, and Zip Code <br /> Ally Colavita Vicki McCartney <br /> Authorized Agent Name (please print) Agency Contact Name (please print) <br /> Signature: <br /> Signeture: <br /> Title: Pro*ect Scientist Title: Senior �e 1 s+er env' on m <br /> +deal s10ec7a l ist <br /> Telephone: 209 463-1006 Telephone: (209 ) 46 8 - 9 85 z <br /> FAX: 209 467-111 _ FAX: (209) <br /> Date: 03/02/11 _ Date: <br /> E-mail: acolavita a v eoenv.Corn _ E-mail: V m CCLt r+rn e )1 @ <br /> / v <br /> 06 July 2006 <br /> wcr request-agencystudy_20 0706.doc <br />