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`01 <br /> ' I <br /> �i <br /> l What is the depth to groundwater? <br /> 7 <br /> Descrllie the sourceof Infom atlnin S '� <br /> • [ 1 <br /> IJ. Are Ihcre any biter wells on this parcel or adjacent propertks? TIESNtI)(1 <br /> TIM,for VYlridq I/18rANCR'1'O TJAM110 <br /> ruhllc Well t' <br /> rrlrate Well/rrlgallon WellMonitoring We"Other I' <br /> lA, Will Ilse Iank(s) pending closure be replaced with an aborgpronnd or aadertromW storage tank($)? YL81 1 NUL 1 <br /> Indicate the responsible party to be Miled for additional 1`113-6111) staff time expended beyond 3 hour arbdawtn <br /> plrmll payment per tank. It the party designated blow Is different than the permit appltelmt,e.g• proper?aw�o <br /> III, Forty mus! Ilcknowiedge this responsibility for the billing by slgnafurs and dale beiorr. i <br /> I. <br /> Nnnte • ' <br /> tilalling Address ' Jaz <br /> o <br /> my rhone Number <br /> 1 <br /> hir onto <br /> . I I <br /> 1 .. <br /> Page 6 <br /> •' I <br /> • I 'I <br /> I <br />