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� 1I <br /> l2. What Is the depth to groundwater? <br /> 40-45' <br /> Describe the source of Informations The City of Lodi ground water map <br /> IJ. Are (here any water wells on this parcel or adjacent properties? YM [ ] NO 1� <br /> TYPE OF WELLS DISTANCE TO TANIVS(S) <br /> Public Well ff• <br /> Private Well n• <br /> Irrignllon Well n• <br /> Monitoring Well ft. <br /> Other n• <br /> 14. WIII the lank(s) pending closure be replaced with an aboveground or underground storage tank(s)7 YES[ ] <br /> NO[ ] <br /> 15. Indicate the responsible party to be billed for additional PIIS•EIID staff time expended beyond J hour minimum <br /> permit payment per Imik. If(lie party designated below Is different llmn the permit applicant, e.g. properly owner, <br /> the party must acknowledge llds responsibility for the billing by signature and dale below. <br /> Name (tee S/ / c:/i �G �✓) <br /> Melling Address /Z�7C' — <br /> Day Phone Number L��! -5 t U �J <br /> Signature Date <br /> Page 6 <br />