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SEP 23 '93 11:10 RESNa FREMO.HT GEO <br />U <br />12. Whitt is the depth to dratndawtetR <br />�it sK' <br />Descdbe the source Or IeNrmetion: <br />P. 4/4 <br />13. Are there arty wow wells on this pared or adjacent properties? YES [ 1 NO I I <br />TYPE OF WEXiB <br />DWANC6 TO TAN KSM <br />Public wall <br />it. <br />Private Well <br />R <br />IrM=adon Well <br />R <br />Monitoring well <br />It. <br />Other <br />it. <br />14. Will the tanks) pendhtg closure be replaced with on abovaggrosml or mdmpo0d storage tutk(s)? YES[ I NO[ I <br />15. Indicate the responsible party to be b0led for additional PAS -ESD staff time mrpended beyond 3 hour mdnimum <br />permit payment per bmk It Ike porky deslputed below N d(Abrant than the Int applicant, e.g. property owner, <br />dw party mum admowledge this responsibility for the billing by signature and date below. <br />Name <br />main Address ? /341 -2AOr a —,Dc <br />Day Phone Number <br />page 6 <br />Data <br />