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.I <br /> 12. What is the depth to groundwater? �� I� � <br /> estimated 75 to 120 fe;gr__ - - <br /> Describe the source of information: U <br /> If <br /> none <br /> 13. Are there any water wells on this parcel or adjacent properties? i� YES [ ] NO ]*known <br /> { <br /> l <br /> I� <br /> TYPE OF ViELIS DISTANCE TO TANKS(S) I� <br /> Public Well ft. I <br /> Private Well ft. <br /> Irrigation Well Ct. <br /> Monitoring Well ft. <br /> i� <br /> Other ft. <br /> 14. Will the tank(s) pending closure be replaced with an aboveground or,l`undergronnd storage tank(s)? YF.S[A NO[ ] <br /> 15. Indicate the responsible party to be billed for additional PHS-EHD stuff 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 mast acknowledge this responsibility for the billing by signature and date below. <br /> Name Mr, Heng Chea i <br /> Mailing Address 2512 E. Waterloo Road, Stockton, Ca ,95245E <br /> Day Phone Number ( 249 463 4114 <br /> :x <br /> y 19 September, 1997 <br /> Signature Date <br /> g i <br /> 'I <br /> II . <br /> 17 <br /> i� <br /> f� <br /> `t <br /> 'i <br /> Page 6 <br />