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Oct 09 06 09: s6a R R EnJ*ering 81884237609 p- 6 <br /> 12. What is the depth to groundwater? 14 Tb 271 <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [) NO() <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well ft. <br /> Irrigation Well ft. <br /> Monitorin Well ft. <br /> Other & <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)? <br /> YES[J NO[J <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 rand date below.Ft <br /> Name t Z) <br /> Mailing Address 207 W At-Al?� .F/7yE LCJ7K CA 9/5 o z <br /> Day Phone Number <br /> lure Title Date <br /> EH 23 046 (Revised 8/9/06) 6 <br />