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12. What Is the depth to groundwater? �C 0 <br /> Describe the source of Information: <br /> 13. Are there any water wells on this parcel or adjacent properties? <br /> YES [[ NO[] <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well 1< <br /> Private Well <br /> Irrigation Well tL <br /> Monitoring Well tL <br /> Other I'L <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)?YES[J NO[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 acimowledge <br /> this responsibility for the billing by signature and date below. <br /> Name 4-e 4d J1--YYL (l 0vi 411))i-III 3J n�1 <br /> MaillngAddrese h2c C,.—T "rPitt.G�2:� Yx <br /> Day Phone Number( r�i pll 1 wt[`'� rx' J f <br /> Slim???a Title Dath <br /> EH 23 046 (Revised 10/19/98) Page 6 <br />