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12. <br />i- <br />What is the depth to groundwater? <br />Describe the source of information: <br />On—site monitor wel <br />13. Are there any water wells on this parcel or adjacent properties? YES [ ] NO [4 <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft. <br />Private Well <br />ft. <br />Irrigation Well <br />tL <br />Monitoring Well <br />12 ft. <br />Other <br />ft. <br />14. Will the tanit(s) pending closure be replaced with an aboveground or underground storage tanit(s)? YES[ I NO[J <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 A. Teichert & Son, Inc. <br />Mai0ngAddress P.O. Box 15002 Sacramento, CA 95851 <br />Day Phone Number( 916 ) 386-3716 <br />Z&W- off_ Project Manager 10-3-00 <br />Signature — Title Date <br />EH 23 046 (Revised 08/13/99) Page 6 <br />