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12. What Is the depth to groundwater? <br /> Unknown by contractor <br /> Describe the source of information: <br /> 13. Are there any water webs on this parcel or adjacent properties? I�YES NO <br /> TYPE OF WELLS I DISTANCE TO TANKS(S) <br /> Public Well n• <br /> — -Private Well <br /> Irrigation Well it. <br /> Monitoring Well I ft. <br /> Other I M <br /> 14 Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)?YES[)NON <br /> 15. Indicate the responsible party to be billed for additional PHS•EHD staff time expended beyond 3 hour minimum Permit payment <br /> per tank. if the party designated below is different than the permit applicant,e.g.property owner,the party must acknowledge <br /> this responsibility for the billing by signature and date below. <br /> Tony Jockvich Trust , c/o Marie Lopez, Trustee <br /> Name <br /> 8567 Orford Rd. , Stockton, CA 95215 <br /> Mailing Address <br /> Day Phone Number( 209 ) 948-2482 <br /> �.1 ,!�, 30- r3 <br /> Signature Title Date <br /> EH 23 046 (Revised 08/13/99) Paee 6 <br />