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RM <br /> i-i <br /> 1 SURVI Y R2G&iM �8"-RCN <br /> $I� BilRYgx AND <br /> page 2 <br /> III. Distance to Nearest Adjacent properties: <br /> c�--. ft. <br /> Etesidentisl �� ft. <br /> r�7 ft. <br /> Commercial "' 7oGc ft- <br /> industrial <br /> Hospital r .eAn�2,cCLe L ++�� s���y �c ft. <br /> School ( N�^"` <br /> Name <br /> IV. Aquifer Classification, if available. <br /> Class i - Special Ground Waters water <br /> Irreplaceable Drinking <br /> Source Vital — �---"~ <br /> - Ecologically - <br /> Clase YY - Current andpotential <br /> Drinking water <br /> Class IIY - 14ot Potential Source of <br /> Drinking dater <br /> - V. Describe observation wells, if any. <br /> N <br /> Humber y N Free Product? <br /> VI. Signature of Preparers <br /> Date! <br /> VII. Sketch of Site <br /> Sl S Ire <br />