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12. What is the depth to groundwater? <br />Describe the source of information: <br />13. Are there any water wells on this parcel or adjacent properties? YES [) NOX <br />14. WW the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ J N0De <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 <br />Mailing Address 47 � AQ <br />Day Phone Number ( 0-6 Y 1 g 3-9 D? 1 <br />- �lr. <br />Signature _ Title Date <br />EH 23 046 (Revised 08/13/99) Page 6 <br />/NFM <br />O TANHS(S)fLftft <br />Monitoring Well <br />ft <br />Other <br />ft. <br />14. WW the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ J N0De <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 <br />Mailing Address 47 � AQ <br />Day Phone Number ( 0-6 Y 1 g 3-9 D? 1 <br />- �lr. <br />Signature _ Title Date <br />EH 23 046 (Revised 08/13/99) Page 6 <br />