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Ll <br />12. What is the depth to groundwater? <br />Describe the source of information: <br />13. Are them any water wells on this parcel or adjacent properties? <br />rb"V <br /># <br />Cl <br />YES k] NO H <br />14. Will the tank(s) pending closure be replaced with an aboveground or and and storage tank(s)? YES[ I NO (XJ <br />15. Indicate the responsible party to be billed for additional PHS- EED staff time expended beyond 3 hour minimum <br />permit payment per tank. If the party designated below is different than the permit applicant, e.g. property owner, <br />the party must acknowledge this responsibility for the billing by signature and date below. <br />Name Iodl Memo=123 Hospital <br />Mailing Address 975 S. Fairmont Avenue, Lodi, CA 95240 <br />Day Phone Number 2 0 9 334-2411 <br />Date <br />I <br />Page 6 <br />