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12. What Is lite depth to groundwater?. <br /> Describe the source of Infonnallont <br /> IJ. Are there any tvoler wells on (his parcel or adjacent properties? <br /> YES [ I NO X <br /> 7Y1'F.OF WF.I.13 1)IS7'AN(:1 TO TANKS(S) <br /> Public Well It. <br /> private Well n. <br /> Irrigation Well ft. <br /> Monitoring Well fl. <br /> Other ft. <br /> 14. Will the Imtk(s) pending closure Ire replaced with an shoveground or underground storage lank(s)? YES[ I NO[ 1 <br /> 15. Indicate the responsible party to be billed for additional PIIS-EIID staff thue expended beyond 3 hour minlmuul <br /> permit payment per tank. If lite party designated below Is different Ilmn the permit applicant, e.g. property owner, <br /> the party must acknowledge this responsibility for the billing by signature gild dale below. <br /> ! Nnme NORMAN HIGGINS <br /> MnllingAddress P. 0. Box 369, Clements , CA 95227 <br /> Day phone Number ( 209 ) 759-3400 <br /> x <br /> Signature Dale <br /> i <br /> Page 6 <br />