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Oct 09 06 09:56a <br />12. <br />13. <br />14. <br />R R E*eering <br />818842378 P.6 <br />What is the depth to groundwater? 14 r0 Z71 17 _CL?j <br />Describe the source of information: <br />Are there any water wells on this parcel or adjacent properties? YES [] NO[ ] <br />TYPE OF WELLS <br />DISTANCE TOTANKS(S) <br />Public Well <br />ft. <br />Private Well <br />ft. <br />Irrigation Well <br />ft. <br />Monitoring Well <br />ft. <br />Other <br />ft. <br />Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? <br />YES[ ] NO[ ] <br />15. Indicate the responsible party to be billed for additional EHD staff time expended beyond 3 hour <br />minimum 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 billing by <br />signature and date below. - <br />Name !t + <br />Mailing Address 207 w ALAm AvE t2BC�'7K6q -C71.50?- <br />Day Phone Number <br />hrre Title Date <br />EH 23 046 (Revised 8/9/06) <br />