Laserfiche WebLink
12. What is the depth to groundwater? <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [] NOX <br /> TYPE OF WELLS DISTANCE 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)pending closure be replaced with an aboveground or underground storage tank(s)? <br /> YES[]NO <br /> 15. Indicate the responsible party to be billed for additional EHD staff time expended beyond 3 hour <br /> minimum permit payment per tank. If the party designated below is different than the permit <br /> applicant, e.g. property owner, the party must acknowledge this responsibility for the billing by <br /> signature and date below, <br /> Name $V—ST' CAL 1-r0?,V'11A GAS LtA . -h`4x . Cii h& PA1W-611-T ES CU <br /> Mailing Address 1311,x, lrr er1dl n136qay S4nitt -T;e S rlS CI©G 7Q <br /> Day Phone Number <br /> �2uer� er ���o2�p7 <br /> Signature Title Date <br /> EH 23 046 (Revised 11/21106) 6 <br />