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04/21/2003 10:37 6027280708 BLAES PAGE 02 <br /> N� ES R S A NC <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 Fairmont Avenue <br /> Sacramento, CA 95816 Red Bluff, CA 96080 Fresno, CA 93726 <br /> (916)227-7832 (530)529-7300 Glendale, CA 91203 <br /> (916)227-7 Fax) (559)2303300 � <br /> (530)529-7322(Fak) (81 B)5.3-4D <br /> (559)2303301(Fax) (8 18)543-A&M(Fax) <br /> WELL COMPLETION REPORT RELEASE AGREEMENT-AGENCY <br /> (Government and Regulatory Agencies and their Authorized Agents) <br /> Project/Contract No. <br /> County <br /> Township, Range, and Section, ,4���,,�, <br /> (Must indude entire study area and a maver �n__4P <br /> ap that s OWS the a of iMer'egt}i 30—Radius <br /> Under California Water Code Section 13752, the agency named below requests pemnission From <br /> 2'7oI NW ISe� Wa <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 /> DMake 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 made available for inspection by the public out <br /> written authorization from the owner(s) 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 /> Env,'rortmpsl-}e►I Nea/fb, Uep�. <br /> �S Vil19f?/Y1QI/1�� [nq���'t <br /> Authorized Agents Jca <br /> Government or Regulatory ency <br /> Address Ffc>bt <br /> Address <br /> k 6Zo - 27a <br /> City, State, and Zip Code City, State, an Zip Code <br /> Slnature ` <br /> Si natur <br /> Title <br /> Title , <br /> Telephone ((,pZ-) O?01 ' <br /> leleDhone 8 - <br /> Fax (601L- 72-9- 0-70? F 2 - <br /> Date to <br /> emailb1r�51 m�n�Solr'no C,om E-mail /Yl;n ut nay [- CoLn <br /> 4 <br /> 6 June 2001 <br />