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12. What IS the depth to groundwater? I>��� (,►y `�jHTIL� <br /> Describe the source of information: <br /> 13. Are there any mater wells on this parcel or adjacent properties? YES ]] N074 <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well ft. <br /> Irrigation Wert 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(]NOW <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 C It e h /{ 1 n I / <br /> Mailing Address f 0 0 3,� l 0 Y� Q 1� /7 /�i qby 6 <br /> Day Pbone Number( <br /> vacs . �e�rr& D 3 <br /> Signature ITitle Date <br /> EH 23 046 (Revised 08/13/99) Page 6 <br />