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[SROM :Fuller Excavating & Demo c. FRX NO. : 9168588301 Oct. 17 2000 01:27PM P4 <br /> .2. What is the depth to groundwater? 44919 �11 T <br /> Describe the source of information* rf <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [] NO JU <br /> TYPE OF WELLS DISTANCE TO TANKS(S) _ <br /> Public Well <br /> Private Well ft - <br /> Irrigation Well ft. <br /> Monitoring Well fL 7 <br /> Other <br /> 14. Will the tanks)pending closure be replaced with an aboveground or underground storage tank($)?YES[]NO[] <br /> 15. Indicate the responsible party to be billed for additional PHS•EHD start time expended beyond 3 hour rrdnlmum 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 T— Pal LTeell Oda <br /> MailingAddress <br /> Day Phone Number <br /> Tl — ^� Dare y <br /> :H 23 046 (Rcviscd 08/13/99) Pagc 6 <br /> 10/17/00 TUE 13:11 [TX/RX NO 98171 Ia004 <br />