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Aug 22 01 11 : 59a T RCCUTITE 6r — 952-7631 p. 3 <br /> I2. 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 NO r� <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well it. <br /> Private Well _ It. <br /> Irrigation Well it <br /> Monitoring Well tt <br /> Other ft. <br /> 14. win the tanks)pending closure be replaced with an aboveground or underground storage tank(s)?YES[ Krr <br /> is. Indicate the responsible party to be Wiled for additional PES-EOD staff time expended beyond 3 hour minimum permit payment <br /> per tank. If the party designated below is different than the permit applicant,e.g.property owner,the party must acknowledge <br /> this responsibility for the Mng by signature and date below. <br /> Name ISL &CC-11AJ (_- TL �� ,,,I, ,��� (\) y'11- t7� <br /> Malting Address 35 &U41 ' '^' r�"�t" �hUN4 L�JU1`", h RCnL'r,is �) <br /> Day Phone Number(tG.r o ) Q 52-6551 _ CA qL 08 d <br /> 0 <br /> �� �d4 <br /> SI® re Tide Date <br /> �zgeaj <br /> EH 23 046(Revised 08113199) Page 6 <br />