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n <br />12. <br />13. <br />14. <br />0 <br />What is the depth to groundwater? <br />Describe the source of information: <br />SITE NUMBER 7 <br />UNMONN AT TRIS TI141E <br />Are there any water wells on this parcel or adjacent properties? <br />TYPE OF WELLS I DISTANCE TO TANKS(S) <br />Publ7WellPriv <br />ft. <br />Irrigation Well <br />ft. <br />Monitoring Well <br />ft. <br />Other <br />ft. <br />0 <br />YES [ ] NO <br />Will the tank($) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ j NOP <br />15. Indicate the responsible party to be billed for additional PHS-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. propern <br />owner, the party must acknowledge this responsibility for the billing by signature and date below. <br />Name STOCKTON PORT DISTRICT <br />Mailing Address PO BOX 2089, 5"i'OCK'ION, CA 95201-2059 <br />Day Phone Number ( 209 ) 946-0246 <br />ALIST <br />Signat r <br />Title Date <br />EH 23 046 (Revised 9111196) Page 6 <br />