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12 <br />13. <br />What is the depth to groundwater? n CD <br />Describe the source of information: jokok M/ r �� /Pft? <br />Are there any water wells on this parcel or adjacent properties? YES �q NO [ ] <br />4) <br />t -k <br />xP <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage <br />tank(s)? YES[ ] NO <br />15. Indicate the responsible party to be billed for additional EHD staff time expended beyond 3 <br />ILI <br />permit payment per tank. If the party designated below is different than the permit applica <br />owner, the party must acknowledge this responsibility for the billing by signature and date E <br />Name <br />Mailing Address nD ,2 a <br />Day Phone Number r(,iC <br />Title <br />1 <br />Signature <br />N <br />EH 23 046 (Revised 3/15/02) Page 6 <br />—/go - <br />Date <br />r minimum <br />e.g. property <br />