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1 <br /> What is the depth to groundwater? <br /> Describe the source of information: <br /> I& Are there any water webs on this parcel or adjacent properties? Y8S [] NOX <br /> I <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well ft. <br /> Irrigation Well M <br /> Monitoring well ft <br /> IOther fL <br /> 14. Wi1I the tanit(s)pending closure be replaced with an aboveground or underground storage tanh(s)?YES[I N <br /> Indicate the responsible party to be billed for additional POSED staff time expended beyond$hour minlmam permit payment <br /> per tank If the party designated below is different than the permit applicant,e.g.property owner the party nm st aelmowiedge <br /> this responsibility for the billing by signature and date below. <br /> Name��i d- A S }I`_.].�►,�5 <br /> 1 MallingAddress 9p SuN 5E ��\yam_ 2.oCa T-�kN awo r_„(i cl_1LP S14 <br /> Day Phone Number( ) 3 15 <br /> I <br /> GW ! z Z N GE-N i 70 ,,.0 14 N t <br /> Slgnature Title. Date <br /> 1 <br /> I <br /> I <br /> E 046 (Revised i0/19/98) Page 6 <br /> I <br /> I <br />