Laserfiche WebLink
10/17/2000 09:00 2094683x43 FIFTH FLOOR PAGE 06 <br /> 12 What is the depth to groundwater? )Yl B! j <br /> Describe the source of information <br /> 13. are there any water wells on this parcel or adlaaeM properties? YES H Noll <br /> r <br /> WELLS DISTANCE TO TAKUP <br /> elWell ft <br /> aWell ftag Well ft, <br /> ft. <br /> 14. Will the tauXs)pending closure be replaced with an aboveground or underground storage tank(s)?YES[I NO[1 <br /> 15. Indicate the responsible party to be billed for additional PHS-HHD staff time expended beyond 3 Lour minimum permit payment <br /> per tank. If the party designated below Is different than the permlt applicant,e.g.property owner,the party must acknowledge <br /> this responsiblllry for the 41=9 by signature and date below. <br /> Mama— MASON_ CFNTFR._11 C <br /> MaftffAddress R _ ()_ ROY 9728 NANVTI I F ('A 94596 <br /> DapPhimeNumber( 92r, I_gRR_n'inn <br /> OC✓n/�� <br /> siEsatare✓ G Title Date <br /> EH 23 046(Revised 08/13/99) Page 6 <br />