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• F- <br /> 12. What is the depth to groundwater? <br /> '�JoPaox . �o <br /> Describe the source of information: <br /> -57,0C.rrO1Y MY/C/ PAL U T 1A rle-S Dis7-rz CT <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [I NO[ <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well ft. <br /> Irrigation Well ft. <br /> Monitoring Well ft. <br /> Other ft. <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage, <br /> tank(s)?YES[j NOt4, <br /> 15. Indicate the responsible party to be billed for additional EHD staff time expended beyond 3 hour minimum <br /> permit payment per tank. If the party designated below is different than the permit applicant,e.g.property <br /> owner,the party must acknowledge this responsibility for the billing by signature and date below. <br /> NameI��jjc��,,,, ,� ^^,,,,� <br /> Mailing Address 2� E. IiWr// /1 {tet°.� Rm—iL'U v cet d7t �A 9s�y <br /> Day Phone Number( )�2- <br /> pnr)e, <br /> Signature Title I Date <br /> EH 23 046(Revisedl0/16/03) Page 6 <br />