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12. What is the depth to groundwater? () 7 Sf / G e s/C/Cle7e---t,/ <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [] N006� <br /> l <br /> LLS DISTANCE TO TANKS(S) <br /> @. <br /> #IZL <br /> ft, <br /> ft,ft,ft. <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)? YES[] Nok <br /> 15. Indicate the responsible party to be billed for additional 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 <br /> owner,the party must acknowledge this responsibility for the billing by signature and date below. <br /> X/ <br /> Name /)�CZ3/ZL/.t) £ffL E5 7,4;3� /rJ 1d �T�lf�✓T �/�r.11 Xc <br /> Mailing Address _ n 2 L2 , / aY <br /> Day Phone Number / 3/—./ <br /> w E/Z /0 <br /> Signature Title <br /> Date <br /> EH 23 046 (Revised 07/31/08) 6 <br />