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.001 <br />."W <br />12. What Is the depth to groundwater? f j P p (L 034 , <br />Describe the source of Information <br />CUV,RENr REMF1)lATt0AJ P9oTEe-T 4 SLocKS t7owAl THE STREET <br />(d Ste! s £. if r_ y(Yr:c.'r <br />13. Are there any water wells on this parcel or adjacent properties? YES 11 NOI <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft. <br />Private Well <br />ft. <br />Madan Well <br />ft. <br />Monitoring Well <br />ft. <br />Other <br />ft. <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES( I N9K <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 />Name 0,17-(/ O F / X,4 C - <br />Mailing Address <br />l..'/S?I'�7L/1/.!�/G7AD/Ilii!•J�1� <br />Day Phone Nwnber/ • <br />I z/Pip,. <br />l� 6 MA <br />EH 23 046 (Revised 10/19/98) Page 6 <br />