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- APR -30-193 09:51 TEL N0:6058350545 #115 P03 <br />o4 -i5 -i9 gl- 04-.14PM FFUM TO ler 03,57717 P.03 <br />w 0 <br />What is the depth to V"ndwaw. <br />Describe the warce of Wormadom <br />Will the tank(s) pending clasure be replomfid, with an abovqp1,, or undeirround storage tank(s)? YES[ I N <br />IS.) 1 <br />I Indicate the responsible party to be billed for additional Pas -DID staff dme minim <br />expended beyond 3 honr um <br />permit payment per tank. It the party desig"ted below is diff6rcat thmi the permit applicant, e.g. property OW4MR <br />the party must acknowk-dr this responsibility for the billing by signature tud 4ate beluw. <br />N -a me <br />Mat If jig Addre ss 15 A0 Q/ <br />Day Phone Number <br />Silrature <br />Date <br />jj <br />.. ... ............. <br />Will the tank(s) pending clasure be replomfid, with an abovqp1,, or undeirround storage tank(s)? YES[ I N <br />IS.) 1 <br />I Indicate the responsible party to be billed for additional Pas -DID staff dme minim <br />expended beyond 3 honr um <br />permit payment per tank. It the party desig"ted below is diff6rcat thmi the permit applicant, e.g. property OW4MR <br />the party must acknowk-dr this responsibility for the billing by signature tud 4ate beluw. <br />N -a me <br />Mat If jig Addre ss 15 A0 Q/ <br />Day Phone Number <br />Silrature <br />Date <br />