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L?. What is the depth to groundwater? <br /> Xn Tn qn FFFT <br /> Describe the source of information: <br /> LLUES-0 F:Q1-1Al T)PPTH- .. . WATFR. �AN -InAlnIN C011NN PARI is WORKS. FAI i nF 1Y99 <br /> 13. Are there any water wells on this parcel or adjacent properties? YES I I NO I I <br /> TYPE OF WEf iR DI43TANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well R. <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 underground storage tank(s)? YES[ I NO141 <br /> 15. Indicate the responsible party to be billed for additional PIIS-EIID 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 rig, ,TACK FRANCTSCn <br /> Mailing Address 8341 ORANGE COURT, ALEXANDRIA VIRGINIA 22509 <br /> Day Phone Number ( X03 I 780 5572 <br /> SEE ATTACHED SERVICE REQUEST <br /> Signmure Date <br /> Page 6 <br />