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12. What Is the depth to groundwater? - 60 {� <br /> Describe the source of information: JJ s <br /> Wc.k t c N cit...c.Fe e( D.. b_ 25, 7.ci (77 n�(Ci� rC:-'i'-+'F <br /> 13. Are there any waterwells on this parcel or adjacent properties? YES W NO[j <br /> UVELI dA, fFD311C.t,•r; �R� r'�1�{ <br /> TYPE OF WELLS DISTANCE TO TANKER it N Kr' <br /> Public Well ft <br /> Private Well tL <br /> Irrigation Well It. <br /> Monitoring Well M <br /> Other ft. <br /> 14. Will the tanks)pending closure be replaced with an aboveground or underground storage tank(s)?YES[)NO[e <br /> 15. Indicate the responsible party to be billed for additional PUS-EBB staff time expended beyond 3 hoar mialmum 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 pNizDc �1)RTi{ 'T�1N <br /> lI+ct cGtCt <br /> Ma111ngAddress IN ✓gogwK VJCST Ga-L,-- Ivire T— <br /> Day Phone Number( Z O y ) 2 2�'i— 0S 0 <br /> I <br /> 3/1 io 2— <br /> Signature <br /> Signature Title Dale <br /> I <br /> I <br /> I <br /> EH 23 046(Revised 08/13/99) Page 6 <br /> I <br />