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12. What is the depth to groundwater? r <br /> Describe the source of Information* <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ ] NO [l]—' <br /> TYPE OF WELLS IJiSTANCE TO T:NJ <br /> Public Well <br /> Private Well Irrigation Well Monitoring Well Other <br /> 14. Will the tank(s) pending closure be replaced with ait'alwreground or underground storage tank(s)? YES[ ] NO[ ] <br /> 15. Indicate the responsible party to be billed for addillonul PIIS-EIII) stuff 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 )la , <br /> �r <br /> Mailing Address <br /> r <br /> Day Phone Number (2 C--' ? <br /> 4L <br /> Date <br /> S gnuture <br /> r <br /> Page 6 <br />