Laserfiche WebLink
12. What is the depth to groundwater? <br /> (rRouMO Wfti�Jt LS APWDX A4,grL y /4 ' ,b !r5 <br /> Describe the source of information: <br /> Cctc�yi (r6NERAL Kn�o VJc 0.06-9- oFA2cA cry r2cco",s <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ ] NOA <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft <br /> Private Well ft <br /> Irrigation Well ft <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)? YES[ ] NOA <br /> 15. Indicate the responsible party to be billed for additional PHS•EHD staff time expended beyond 3 hour minimum <br /> permit payment per tank. If the party designated below is different than the permit applicant, a g. property owner, <br /> the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name TM c CST c9 F T2ALV ATA) PAOL V 4eMt4. <br /> Mailing Address 52 TP-ACV 4LJO T2�/ CA cIS.7,� <br /> Day Phone <br /> Number <br /> Signature Date <br /> Page 6 <br />