Laserfiche WebLink
0 <br />12. What is the depth to groundwater? <br />Describe the source of information: <br />13. Are there any water wells on this parcel or adjacent properties? YES [ ] NO [ ] <br />TYPE OF 31 <br />DISTANCE TO TANKS(S) <br />Public Well <br />& <br />Private Well <br />M <br />Irrigation Well <br />M <br />Monitoring Well <br />M <br />Other <br />ft. <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ] NO[ ] <br />15. Indicate the responsible party to be billed for additional PHS-EIID staff time expended beyond 3 hour minimum <br />permit payment per tank If the party designated below is different than the permit applicant, eg. property owner, <br />the party must acknowledge this responsibility for the billing by signature and date below. <br />Name T Si ll ( i -AL- <br />Mailing Address <br />14 CA %7X - <br />e -""5 <br />Day Phone Number( 94 ) <br />DafW' <br />7 <br />Page 6 <br />