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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 [] NO[] <br /> TYPE OF WBL1.4 DISTANCE TO TAMS(S) <br /> Public Well ft <br /> Private Well ft. <br /> Irrigation Well 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[]NO[] <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 <br /> Day Phone Number( ) <br /> Signature Title Date <br /> EH 23 046(Revised 08/13/99) Page 6 <br />