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11 <br />11 <br />12. What is the depth to groundwater? -j <br />Describe the source of information: \ <br />5oiI -� Groun8waifr a-meSTiechon Report (Geo Icc�IMa Teck n I 0-S -TrJ C- . r3 I9q's, <br />13. Are there any water wells on this parcel or adjacent properties? YES I J N0 <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft. <br />Private Well <br />ft. <br />Irrigation Well <br />ft. <br />Monitoring Well <br />ft. <br />Other <br />fL <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? VENO[ j <br />15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended 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 must acknowledge <br />this responsibility for the billing by signature and date below. <br />Name Cardoza E'�e-r f-te' <br />Mailing Address P 0 . (t)c)X ► 0 22 n a n -'e Col. C101�t 533(0 <br />Day Phone Number ( Z OC ) 2 3 - 4 14 � <br />&&'1/a ' za4i 4-P, / dV,&-;i, 8-27-1:18 <br />Signature , Title YDate <br />EH 23 046 (Revised 10/19/98) Page 6 <br />