Laserfiche WebLink
04/13/2007 THU 14: 55 FAX 20083433 SJC ESD � Qj610/012 <br /> 12. Vvl:at is the depth to groundwater? <br /> De scribe the source of information <br /> 13. Art there any water wells on this parcel or adjacent properties? YES [t NOX <br /> TYPE OF WELLS f3JSTANCE TO TANKS($) <br /> Public Well ft, <br /> Private Well ft, <br /> Irri ation Well ft. <br /> Monitoring Well ft. <br /> Other ft, <br /> , <br /> 14. Wil I the tanks)pending closure be replaced with an aboveground or underground storage tank(s)? <br /> YE:-,[]No <br /> Ia. Ind.cate the responsible party to be blued for additional EHD staff time expended beyond 3 hour <br /> minlmum permit payment per tank. If the party designated below is different than the permit <br /> applicant,e.g.property owner,the party must acknowledge this responsibility for the biiling by <br /> sigr:ature and dktte below, <br /> Name IN5— CAL 14:) JA- GAS U8 , CiiP-1S PA*JA:-1- FSC <br /> Mailing Address 1311 ", im.'Perial Wq War Sgn 1 s in-Rs a�C& 90G70 <br /> Day Phone Numbe ) 2 I Lzi( l <br /> 5igr attire Title Date <br /> 13H 23 046 (Revised 11121/06) 6 <br />