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12. What Is the depth to groundwater? <br /> Describe the source of Information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES (] NO[] <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well It_ <br /> Irrigation Well it. <br /> Monitoring Well ft_ <br /> Other it <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)?YEVNO[1 <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 J��TN4/v? <br /> Mailing Address 574 k/. aiQAW i,G/ME R-6; L.e ety ,0- 4 c76-37,/ <br /> Day Phone Number 2( p q 1 533 — 31f 4 <br /> s.C' f?G 1HE,,e /1- <br /> Signature Title Date <br /> EH 23 046 (Revised 10/19/98) Page 6 <br />