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12. What is the depth to groundwater? <br /> AP-PROX 6 TO ';() €T t� <br /> Describe the source of information: <br /> GEOLOGIST <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ ] NO K] <br /> NON AWARE OF <br /> TYPE OF WELLS DwrANCE 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 undergromW storage tank(s)? YES[ ] NO[ ] <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, e.g. property owner, <br /> the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name ATTORNEY DONALD D, BOSCOE, AGENT <br /> Mailing Address 45 HUNTER SQUARE PLAZA, STOCKTON. LA 95202 <br /> Day Phone Number ( 209 ) 4b5 5b28 <br /> SEE SIGNED SERVICE REQUEST ATTACHED <br /> Signature Date <br /> Page <br />