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(�. Mint Is the depth to groundwaierl <br /> f0 <br /> Describe the source of#nrormnifont -5 1 <br /> l 1 Are there any water welli on Ihllt parcel or adjacent properties? YES ( ] NO <br /> r <br /> WF1.L,S UIWANCE"1O TANK9(S) <br /> ell n <br /> ell Wellg Well II <br /> 14 Will the lonk(s) pending closure be replaced with an abovegmand or underground storage tank(s)? YES( ] NO( ] <br /> indlcnte Ilia responsible pnrty Io he billed for ndditlonal PIIS-EIII) staff Ihne expended beyond 3 hour minintum <br /> perntll pnyment per Intik I[the party deltiRnnfed below Is different Ilton the permit npplicant, a g, property owner, <br /> lite party multi acknowledge Ihrlt responstbllity ror Ilse billing by signature and date below. <br /> Name LOUIS E . SHONEFF <br /> Walling Address 1401 W . FREMONT STREET STOCKTON CA 95203 <br /> Uny Phone Nunther L2n9 ? <br /> �� ✓���� 5/9/94 <br /> f ntetre _ <br /> onto <br /> a <br /> Page G <br /> i <br />