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12. What is the to depth groundwater? <br /> P g 3c <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ ] NO <br /> TYPE OF WELI S DLSTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well ft. <br /> Irrigation Veil ft. <br /> Monitoring Well ft. <br /> Other ft. <br /> 14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ] NO[ ] <br /> Is. 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 owner, <br /> the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name P l)/[/J4 ( D S. S/,/( ( i4N <br /> Mailing Address �5 x Z <br /> DayPhoneNumber ( ZpO `� ) S 7 Gi - ��S�'/ M �/t/✓�""GJ osvc <br /> �J� utiwuf� J /w��+ <br /> Signature Date <br /> Page 6 <br />