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v <br />12. What is the depth to groundwater? unknown by contractor - <br />Describe the source of information: <br />13. <br />14. <br />15. <br />Are there any water wells on this parcel or adjacent properties? <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft. <br />Private Well <br />ft. <br />Irrigation Well <br />ft. <br />Monitoring Well <br />ft. <br />Other <br />ft. <br />YES I j NOX <br />Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YESI I NOI I <br />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 <br />owner, the party must acknowledge this responsibility for the billing by signature and date below. <br />Name Arnie Taylor <br />Mailing Address 1912 E. Mettler Rd. , Lodi, CA 95242 <br />Day Phone Number( <br />Signature <br />C%t-c17t:lriL <br />Title <br />EH 23 046 (Revised 9/11/96) Page 6 <br />ApxDat <br />