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12. What ib the depth G)g11)unduater? „prt�'(0 UIXly u)feet <br /> Describe the wturce of infOrmation: Qntutilw nCr dat•t from monitor well W•RX94)1 l��Lttvnari�r,l in 00:� <br /> A220dix A. <br /> 13. Are there any water wells on this parcel tN adjacent prttperti`S? YES ( X NO( 1 <br /> F <br /> F WELLS IDISTANCF TO TANK <br /> elltT-4te W.aer 23(x)/ 144X)ft. <br /> ells Well <br /> ,,•_ �c it>.utetu1uu �+) tt. <br /> oint%) <br /> 1.3. Will the tank(s) pending clo%ure he replaced with an atwn•e%ruund or underground sturage tank(s)? <br /> YES (X ) NO [ J <br /> 15. Indicate the responsible party to be billed for additional 1111S-EHD staff time expended beyond 3(tour minimum permit <br /> payment per tank. If the party demcnitted heluw is different than the permit applicant.e.g. property owner,the party must <br /> acknowledge his re%punstbility fur the billing by signature and date below. <br /> Name ImiM.LivoMin,.r.,.•,D21 r •,Mxatttry <br /> Mailing Addrews71 X)Est AvenueP O Rtsx )% j ivermoxe CA 94550 <br /> Day Phone Number ( 510 1421-6577 <br /> Sienature D <br /> aten <br />