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- < 3 1995 <br /> ✓ <br /> 12. What is the depth to groundwater? � <br /> JUN Z <br /> 7 S ENVIMMUrp1T6i-I IFAFF!I <br /> PERMIT/SERVICES <br /> Describe the source of information: <br /> A (� J I rJ t'z i;n12 c0 tJTkO L �l Co>J s ERvam 00 &441or <br /> Z o hp,1 - 1`-tl — S P I tJ O <br /> ✓ 13. Are there any water wells on this parcel or adjacent properties? YES [ ] NO [ ] <br /> TYPE OF WELLS DISTANCE TO TANSS(S) <br /> Public Well ft <br /> Private Well ft. <br /> Irrigation Well it <br /> Monitoring Well ft- <br /> Other ft. <br /> 14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YFS,k] NO[ 1 <br /> 1�. Indicate the responsible party to be billed for additional PHS-= staff time expended beyond 3 hour minimum <br /> permit payment per tank. If the party designated below is different than the permit applicant, e.g. property owner, <br /> the parry most acknowledge this responsibility for the billing' by signature and date below. <br /> Name11Y��C ` �-717�-� ecy�U�T,]�rW�1 ILJ� <br /> Mailing Address 3E'200 /T\r l/PdVIJ/Y� 1Hi� c2 op 9sS-7 6 <br /> Day Phone Number ( 130 XZJ p S <br /> % - U/- <br /> (' . Ni,>-,,,�, �A6r� (- 6 -95- <br /> Signature Date <br /> Page 6 <br />