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• 0 <br />12. What is the depth to groundwater? " ,.Z ,� S ' <br />Describe the source of information: r <br />N-uwa :z-2 /�rnv, �z,�� .>,a KPL • •✓G <br />13. Are there any water wells on this parcel or adjacent properties? <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft <br />Private Well <br />ft <br />Irrigation Well <br />ft <br />Monitorin Well <br />ft, <br />Other <br />ft. <br />YES f M NO[ ] <br />14. Will the tank(s) pen g closure be replaced with an aboveground or underground storage <br />tank(s)? YES[ ] NIX <br />15. Indicate the responsible party to be billed for additional EHD staff time expended beyond 3 hour minimum <br />permit payment per tank. If the party designated below is different than the permit applicant, e.g, property <br />owner, the party must acknowledge this responsibility for the billing by signature and date below. <br />Name -----k MtVLCAAtq' <br />Mailing Address Si OckTtw aL✓� S 7Lr ,ZSa CA <br />Day Phone Number( q l ) _ ¢ �jr / 2- .� ✓(� Z <br />06LI 7/0!1 <br />Signature 7"o•N. $K ofZ Title <br />Date <br />C !® r aeA <br />n Q <br />EH 23 046 (Revised 10/16/03) Page 6 <br />