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11/02/2001 10:47 91GG81 1 <br />R <br />12. What 1s the depth to dwater? <br />DMmdbO the sgaree of WOMOOM <br />GEOFON INC <br />18. Are there anywater wells on this parcel or adjacent properties?rk <br />PAGE 08 <br />Public Well tt. <br />Private won rt. <br />irrlgatioa Well It. <br />Pelt <br />ik <br />bo Q� T <br />Other ft. <br />14, WW the s) pending closure be replaced idtb d or mhMVO=d storage s)? NO' ] <br />15. indlcate the responsible party to be Med for additionul PHS.MW staff tixne expended beyond 3 hour mlabaum vexidt Payment <br />per tuk if the party designated below is different than the pannit applicant, e.g. property owner, the party mut a owledge <br />We remponalbility for the Ming by 91guturG and data below. <br />Name <br />9. <br />mailing Ad �� 0/IV X f .S' U / 7 -if D <br />Day Phone limber ( 1 �'/ ' , -d O <br />tt�e Title Date <br />EH 23 046 (Revised 08/13/99) Page 6 <br />