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12. What is the depth to groundwater? unknown by contractor <br />Describe the source of information: <br />13. <br />14. <br />15. <br />Are there any water wells on this parcel or adjacent properties? <br />TYPE OF WELLS <br />DISTANCE TO TANES(S) <br />Public Well <br />it. <br />Private Well <br />tL <br />Irrigation Well <br />it. <br />Monitoring Well <br />rL <br />Other <br />fC <br />YES [] NO [ f <br />Will the tank(s) pending closure be replaced with an aboveground or underground storage tanlgs)? YES[ j NO[f <br />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 />Mallin <br />Dap Phone Number ( -2 Of ) �6 117� .5 --Ta <br />/2 � �f <br />Date <br />EH 23 046 (Revised 10/19/98) Page 6 <br />