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{ <br /> d,l <br /> M What is the depth to groundwater? 128 ' <br /> peeodbe the source of Information: S MUD <br /> 13. Are there any water wells on this parcel or adjacent properties? YES NO I <br /> TYPE OF WELLS DISTANCE TO TAM6l M <br /> Public Well it, <br /> Private Well 100 it PROX . , CUP WELL <br /> IMKai tlonWoil 2000+ 11. PARCELS Tq THE NORTH & EAST <br /> Monitoring Well it. <br /> Other it. <br /> 14. Will the tanks)pending closure be replaced with an abos aground or underground storage tank(s)?YES[I NOI I <br /> 15. indicate the responsible party to be biped for additional PHS-EHD staff time expended beyond 3 hour minimum penult payment <br /> per tank. It the party designated below is different than the permit appOcant,e.g.property owner,the party must acknowledge <br /> this responsibility for the bIWog by slguawre and date below. <br /> Name LIBERTY FIRE DISTRICT C/O FIRE CHIEF STAN ,S- - RT <br /> MallingAddress 24124 N. BRUELLA RD. , ACAMPO, CAI.IFORNIA 95220 <br /> Day Pbone Number( 209 ) 3 3 9 1329 <br /> FIRE CHIEF �Q- , pZ- <br /> Elaaatufe Title Date <br /> FIRE C IPF 5TJ SEIFERT <br /> EH 23 046(Revised 06/13199) Page 6 <br />