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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 [I NO j <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well It. <br /> Private Well ft. <br /> Irrigation Well ft. , <br /> Monitoring Well ft. <br /> Other ft. <br /> i <br /> 14. Will the tanks)pending closure be replaced with an aboveground or underground storage tank(s)?YESj)Nix') <br /> 15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond 3 hour minimum permlt 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 t✓ 1� a �_ e. .1? trJG <br /> II MalllngAddress11_x-'1© ft7pLS)0, Gi, `14`1'54 <br /> Day Phone Number( 7D`l ) —( Lo —1 %_0 LO O <br /> i <br /> Title ���� D3 <br /> Signature <br /> i <br /> i <br /> I <br /> I, <br /> EH 23 046(Revised 08/13/99) Page 6 <br /> { <br />