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14. <br />15. <br />TYPE OF WELLS <br />I DISTANCE TO TANKS(S) <br />Public Well <br />NIA <br />ft. <br />Private Well <br />140 <br />ft. <br />Irri ation Well <br />340 <br />ft. <br />Monitoring Well <br />N/A <br />ft. <br />Other <br />N/A <br />ft. <br />Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? <br />YE�oNO❑✓ <br />Indicate the responsible party to be billed for additional EHD staff time expended beyond 3 hour minimum <br />permit payment per tank. 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 by signature and date below. <br />Name Neil O. Anderson & Associates, Inc. <br />Mailing Address <br />Day Phone Number <br />Sr. Project Manager <br />Title <br />902 Industrial Way, Lodi, CA 95240 <br />12/31/07 <br />Date <br />EH 23 046 (Revised 813/07) 6 <br />367-3701 <br />Signature <br />