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12. What is the depth to groundwater? /� <br /> belowarti ,� <br /> Describe the source of information: �I i <br /> G.r.i.S (l/WnL�W kseSsrv,,a,� {24_Dol r PAC��'2.. G✓`USfo Y�h�2.wTr,,,� <br /> Grin( <br /> 74A C- el ale el kkIrLIgs. ``// <br /> 13. Are there any water wells on this parcel or adjacent properties? YES NO`/llg� <br /> TYPE OF WELLS DISTANCE TO TANES(b7 <br /> Public Well It. �/�f v /0 <br /> Private Well IL <br /> Irrigation Well IL <br /> Monitoring Well 3 5(� ft <br /> Other R <br /> 14. Will the tank(s) pending closure be replaced with an abovegroaud or noderyjomd storage tank(s)? YES( ) NOp� <br /> 15. Indicate the responsible party to be billed for additional PHS-FHD staff time expended beyond 3 hour minimum <br /> permit payment per tank. If the patty designated below is different than the permit applicant, e.g. property owner, <br /> the patty must acknowledge this responsibility <br /> 9for the billing by signature and date below. <br /> Name CC,( ke;-15+01) V /I O C 60ra�aD ✓1 <br /> i I <br /> Mailing Address 2000 C 'S,;4roto LGtYI�/O✓� Pleye- ui4 400 y Soin Kahim l�63 <br /> Day Phone Number <br /> Q &.1-0 <br /> 1�AJ5b6-ASL14aVi: � uA.oC&) <br /> Sign re Date <br /> Page 6 <br /> L 'd "MIA WV0£' ll 9661—S0—L <br />