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11/17/2006 12:29 RAX <br />Oct 09 06 09:56a <br />R R Elsginowring <br />VALERO ENERGY <br />eleen23760 <br />• p.6 <br />72 wbetistb deplbtogroartdwesa7 14 TO Z'Itic►f�AOE- <br />Dworibe the source of f xfo®atim <br />13. Are there airy water wells on this parcel or adocent Properties? YES 11 NO[ l <br />74 <br />TYPEOFWMS <br />DMANCETOTANYS(S) <br />Public Well <br />fL <br />Private Wen <br />ft <br />Lr�tlmn well <br />ft. <br />Monitoring well <br />ft <br />Other <br />Iit <br />Win the to *4s) pending closure be replaced with an abuvegmmd or andmgnormd sturaga tarrk(s)7 <br />YEs11 NO1) <br />25. Indicate the respomiUe party to be billed for additional MW xta f time wqt ded beyond 3 hour <br />m4iinmm pervot payment per tank If the party designated below fo dd ermt than the permit <br />applicant, e.g. property owmer, the party must adatowledge this rrepandbelty for the baling by <br />signature and date below. <br />Name L-EV—o ( Q TR--4AN —) <br />c— <br />Mmilb%Addrm � fay I�1F_ST'. Tl�ll'I� ST U41VFG 4� C'D �7 � <br />Dsylv,one Nb. <br />r5 1563-3235 <br />Eli 23 096 (Revised 8!9/06) <br />a - d <br />G = -. -7 --00 <br />_ 1» <br />LI <br />1A002 002 <br />09LEZ40818 2U?jaauc3u3 a tf dso;ao 90 L1 ^oN <br />