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12. <br />J <br />What is the depth to groundwater? unknown by contractor <br />Describe the source of information. <br />13. Are there any water wells on this parcel or adjacent properties? <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft <br />Private Well <br />It. <br />Irrigation Well <br />It. <br />Monitoring Well <br />It. <br />Other <br />It. <br />YES [1 NGJJ( <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ 1 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 acknowledge <br />this responsibility for the billing by signature and date below. <br />Name Lavor Thompson <br />Mailing Address 310 N. Cluff Ave., Lodi, CA 95240 <br />Day Phone Number( 209 ) 369-4751 <br />Title Date <br />EH 23 046 (Revised 10/19/98) Page 6 <br />