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12. What is the depth to groundwater? All <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or.adjacent properties? YES NO [ I <br /> ung ookr <br /> TYPE OF WEDS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well ft. <br /> Irrigation Well n. <br /> Monitoring Well R. <br /> Other ft. <br /> 14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ] NO(1'] <br /> 15. Indicate the responsible party to be billed for additional PHS•EHD staff 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 <br /> cmust acknowledge this <br /> "�responsibility for the billing by signature and date below. <br /> Name d �c�U[In l(;AnJ:V MC6J I I Q V & Or/11fV -DQt:r1 L <br /> Mailing Address ` q6q SQ .L(v q �I(C)066 VOJA JiWc M C� Qt3cq(O <br /> Day Phone Number ( 9rA <br /> Signa re Da <br /> Page 6 <br />