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SITE NUMBER 10 <br /> 12, What is the depth to groundwater? <br /> UNKNOWN AT THIS TINIE <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ ] NO <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> WblicWell it. <br /> ft. <br /> ft- <br /> ft. <br /> f 14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ] NO[4 <br /> 16, 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 STOC:KTON PORT DISTRICT <br /> Mailing Address PO BOX 2089, S'IOCKION, CA 95201-2089 <br /> 209 946-0246 <br /> Day Phone Number <br /> i ENV FRONAE `pT 9P LJALIST J0/Cf R <br /> Signature <br /> 4 Title bate <br /> EH 23 046 (Revised 9111/96) Page 6 <br />