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1 <br /> i2 What in the depth to gmund*aJer? <br />' 10 to 15 Leer <br /> f}eseribe the gout-Tv of Informations <br /> `:r'AVECIlS G!O!'k 1CS ".t'IE area, <br /> 1 <br /> 13. Are thus any water +veils on this parcel or adjacent propertles7 YES { ) No �(] <br />' TYPE 01r ffl<Z.i;5 fl LSTANCE TO TANKS(S) <br /> Public Well (t, <br />' Private Well R <br /> Irrigstion Well R <br />' Mnnitoring Well fL <br /> Lot—her ft. <br /> 1014 Will the tanks) pending ciosuia be replticed with all st} "tVvend or andergx nd storage tank(s)? YES( j NO( ] <br /> 15. tndiente the responsible parry to be billed for additional PHS-EHH stair time expended bgvnd 3 hour atln1mum <br /> pertnit paymetit per tank If the party dtslgnattd below 15 dlfrerent than the permit appliesot, cg. prop" owner, <br /> Ithe party must acknowiedgi (lits rrc3"n3lbdfry for the billing by signature and date below. <br /> Name Risers,d,-- Ce-r,en-, Co. , Attention . Mike �eixas <br /> MallinB Addres! P 0. Dox 158, Oro Gtande, CA 92368 <br /> Dar Phone Number ( 619 ) 245-5321 (Re Pur chdse Order no RL 201958) <br /> Signature Date <br /> I <br /> I <br /> Psgc 6 <br />