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0 <br /> 12. What is the depth to groundwater? <br /> Describe the source of information: <br /> A1.0L11A 77-:7Z <br /> 13. Are there any water wells on this parcel or adjacent properties? YES)J NO[] <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well ft. <br /> Irrigation Well ft. <br /> Monitoring Well ft. <br /> Other ft. <br /> 14. Will the tanks en closure p g sure 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 �1 U tz Q..C 4 h1-1— <br /> Mailing Address 9/ L S;iv>ck-TtyL��✓/�T S�w , ZSo-.3 2ILiG �Loy� CA <br /> J J 1 <br /> Day Phone Number( q ) S 9G Z 4 <br /> - -- <br /> 7 _- , /1,� L� ad.//?10 L/ <br /> Signature "Tom i SK.DfZ, Title Date <br /> EH 23 046(Revised 10/16/03) Page 6 <br />