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12. What is the depth to groundwater? J D Li Ut863 Sea,, °IS <br /> Describe the source of informatioa: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ [ NO -K <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft <br /> Private Well I ft <br /> Irrigation Well 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[ J NO)<J <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 \ )!yrlc. P- ;LQ+Z <br /> Mailing Address q?-R1 L .y. .+wm4\ ANA <br /> Day Phone Number ( '1 VA ) �'L U352- <br /> VILt. l SIAAA 12)2-196 <br /> Siw, e Q�d.Mb aba1 Title Date <br /> EH 23 046 (Revised 7/10/96) Page 6 <br />