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07/09/1998 09:03 1209832s'S2 WRIGHT ENVIRONMENT4L PAGE 03 <br /> I <br /> 12, What Is the depth to groundwater? 025 <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ ] NO [ J <br /> TYPE OF WELIS DISTANCE TO TANKS( <br /> Public Well ft <br /> Private Well ft. <br /> Irrigation Well ft <br /> Monitoring Well k. <br /> Other ft <br /> 14. Will the tank(s) pending closure be replaced with an abovegreaad or aadsspoaad storage tank(s)? YES( ] NOky\ <br /> 15. Indicate the responsible parry to be billed for additional PHSEHD sLR time expended beyond 3 hour minimum <br /> permit payment per took If the party designated below is different than the permit applicant, e.g, property <br /> owner, the party must acknowledge this responsibility for the billing tbyf signature and date below. <br /> Name IAlclv� <br /> Mailing Address ! , _ �J - l <br /> Day Phone Number oZd R3R—W//e� <br /> -*,- l _ a,X ,. Date? / q J q$ <br /> Signature Title <br /> EH 23 046 (Revised 9/11/96) Page 6 <br />