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12/18/98 FRI 09:31 FAX 5106096304 RHL DESIGN GROUP --- RHL PETALUMA zoos <br /> 12. What is the depth to groundwater? CA A Ic,n o w <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 TANHS(S) <br /> Public Well ft. <br /> Private Well I ft. <br /> irrigation Well it. <br /> Monitoring Well ft <br /> Other �- <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)?YES[)NO)( <br /> 15. Indicate the responsible party to be billed for additional PH&EHD staff thme Mended 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 mast acimawiedge <br /> this responsibility for the billing by signature and date below. <br /> Name E QLAILCnl F-n- F-=jZFR-ISES �LLG ATrAl . 5PLETT koQLAnIO <br /> Mailing Address O Q DX SO 8 O fiRT Int SZ <br /> Day Phone Number( q�5 ) -75-7- k9'15 <br /> / C <br /> signature Title ' ! Date <br /> EH 23 046 (Revised 10/19/98) Page 6 <br />