Laserfiche WebLink
12. What is the depth to groundwaterT 5z7>— A-K,. ) '' ee–l lln�IL <br /> Describe the source of Information: <br /> tilal ae mA i.� bis lhs? 14443 /I) Qac fzl <br /> 13. Are there any water wells on this parcel or adjacent properties? YES 1] NO <br /> TYPE OF WELLS DISTANCE TO TANHS(S) <br /> Public Well ///Y G ft.f <br /> Private Well / rL <br /> Irrigation Well It. <br /> Monitoring Well d it <br /> Other rL <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)?YESi]NO[J <br /> 15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond 3 hour minimum permit payment <br /> per tank If the party designated below is different than the permit applicant,e.g.property owner,the party must acknowledge <br /> this responsibility for the billing by signature and date below. <br /> Name 1& 1,2 1 <br /> Mailing Address <br /> Day Phone Number( f F ) L)y <br /> Signa T1tle Date <br /> EH 23 046 (Revised 10/19/98) Page 6 <br />