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12. What is the depth to groundwater? iloa nye: 1f �. 7 --/,Y F,— (3E��, S"eyz'4e.r <br />Describe the source of information: <br />13. Are there any water wells on this parcel or adjacent properties? Y,EyS K NO [ J <br />T <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />I ft. <br />Private Well <br />ft. <br />Irrigation Well <br />I ft. <br />Monitoring Well <br />iv $tb ft. <br />Other <br />ft. <br />AJV-1`LE20�a-S MONt'cotz_� VJL=LLS <br />L -0=4T E CI co S 1'r , <br />14. Will the tank(s) pending closure be replaced with a aboveground o underground storage tank(s)? YESXNO[ J <br />15. Indicate the responsible parry 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, eg. property <br />owner, the party must acknowledge this responsibility for the billing by signature and date below. <br />Name La �vie�c� R /�f//�u-�/ <br />Mailing Address /0-0, '80X 960e�ol S fOc./C !Loq' 6,f 9,5-2-96 <br />Day Phone Number ( AO 9 ) 98..2 `30-f-0 <br />4: /el,, -74- s' on Seru/ /o�fi� <br />Signature Title Date <br />EH 23 046 (Revised 9/11/96) Page 6 <br />