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11/15/2002 17:01 916-3F0-4202 PARKCREST <br /> 11/15/2802 14:52 2V '1110PAGE 04 <br /> �.. AGE STOCKTON PAGE 03 <br /> 12. What is the depth to groundwater? <br /> 30 ` <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent Properties? YES (J NO W <br /> TYM of DISTANCE TO <br /> WELLS TAN MS) <br /> Public Well ft. <br /> Private Well R. <br /> Irrisration Well #! <br /> Monitoring Well k. <br /> Other k. <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage <br /> tank(s)?YES[] NOR <br /> 16. 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,thepartymust acknowledge this responsibility for the billing by signature and date below. <br /> Name I�.QV1Vli C � T�,twt <br /> MaMns Address <br /> Day Phone Number O A a 4(2 -d 1e 5 <br /> Signature Title Date <br /> EH 23 046(Revised 3/15/02) Page 6 <br />