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L2. what is the depth to groundwater" <br /> Aoa�x 41 <br /> Describe the source of informatiotr. � lyC2217 2i,NE \� 1994 ZTE ASS e.SS hE�k�r -- <br /> 13. Are there any water wd14 an this parcel or adjacent proQerties^ <br /> YES <br /> 0% S-vt 0t=F St�G <br /> TYPE OF wEIJS DurANCE TO TANSS PCS 1v, <br /> � <br /> Public well F <br /> Private well MW-1 �� <br /> Irrigation well <br /> It <br /> Monitoring wdt �� / <br /> Other V�xR �� Iti' '. R V� '/W'frt <br /> 14. Will the tank(s) pending ciosnre be replaced with an aboveground or underground storage tank(s)" YES( j YO[ j <br /> 15. Indicate the responsible parry to be billed for additional PHS-EEID stag time ecpended beyond 3 hour minimum <br /> permit payment per tank. If the party designated below is different than the permit applicant e.g. property owner- <br /> the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name To C0 <br /> Mailing Address 0 1 L Su1god <br /> Day Phone <br /> Number ( 7.OG) -J- - 000 <br /> Date <br /> Signature <br /> Page 6 <br />