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r ' <br /> c i <br /> 000149 <br /> 12. Wth+t is the depth to groundwater? Fctim tied tobe anPrnzim*1 IV 2Rt1 lent <br /> Describe the source of information: Groundwater dilta in Remedial Irtrecrit'urinrt 11f rlir�lndd+at'x t3 Arrci_ <br /> 1991 110EL AR 117377 as summvized in ne <br /> Anndix A. <br /> 13. Are there any water we1Lc on this parcel or adjacent properties' Yl ti I K I \t)I 1 <br /> L <br /> F WELLS DISTANCE TO TANK <br /> Off-site Water 3000 ft. <br /> ells <br /> Well <br /> e Wrll 4Ut1 ft. <br /> 14. Will the tank(s)pending closure he replaced with an uhoveground or undem!round storage tanYE.Ch[X ] NO ( ] <br /> 15. Indicate the responsible party to be billed fix additional PHS-EHD staff time expended beyond 3!hour minimum permit <br /> payment per tank. If the party designated below is different than the permit applicant,e.g.property owner,the party must <br /> acknowledge his responsibility for doe billing by signature and date below. <br /> Name v N ionall n <br /> Mailing Address 7 ffl)Est AyCn1j6 E..^,. Box RUR Livem a.CA 24'950 <br /> Day Phone Number ( 510 )423 6577 <br /> Sienature Date <br /> 6 <br />