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12. What is the depth to groundwater? -7 S ho <br />Describe the source of information: v <br />0 JAP V U.LII LQ C- • . )'0 V- E Chw IVAy� <br />13. Are there any water wells on this parcel or adjacent properties? <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft. <br />Private Well <br />/aO -3 ft. <br />Irrigation Well <br />ft. <br />Monitoring Well <br />ft. <br />Other <br />ft. <br />YES VINO I I <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES( I NOW <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 JA> l/yG� J Aic -D&A YCQY o kw- e s <br />Mailing Address 3t{ ko (f r// P -Q( a Sloe GA) CA <br />Day Phone Number ( 9 ) �� 2 G) S, <br />7 <br />EH 23 046 (Revised 9/11/96) Page 6 <br />a -a(-R9 <br />Date <br />