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12. What is the depth to groundwater? = VS <br />Describe the source of information: Z.Jj -} <br />3- Na.sl..:_, iwlt/1s OPs•fsaee 4�rara %wn/�s_ �tC✓io�r <br />Tan% remya,cJ q,,.( w *4L,-, <br />a�— <br />-�F4- CUP t A-OtCG — Fa Ci /ifs, R`/ - e'00 4&' -t <br />13. Are there any water wells on this parcel or adjacent properties? <br />TYPE OF WELLS I <br />DLSTANCE 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 />ft. <br />.. 9L •F&C i /.,- <br />3 -we //s <br />YES pQ NO [ <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YESPy NO[ <br />b15V5 alre-dy i,5f4 Med f1 /`IF7.s•t wdJ�cenfi-S.'¢c. <br />15. Indicate the responsible party to be billed for additional PHS-EHD 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 <br />owner, the party must acknowledge this responsibility for the billing by signature and date below. <br />Name Allikncc .Enylronrnem*-' Sery/e-,-r <br />Mailing Address 3060 -7Avrn /rea Or,,'.✓a 4,60 .0 Chico 9'479.73 <br />Day Phone Number( 30 ) 3YS- 6-,5--6;t <br />//- A6 -f,% <br />Signature Title Date <br />A/,4 c. <br />s�4, wr/! br ImArke-W w4ifc /oain� ws /e10a1'reW 6y, /a h. <br />qnd U5 k} L(nderJtrauNd Sarvi'cc A/ri'� �v//% be <o,��«¢tc( ioZ-�aurf <br />6r46rc 4 -AC <br />EH 23 046 (Revised 9/11/96). <br />Page 6 <br />