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12. What is the depth to groundwater: <br /> (r20uN0 wRic/e LS AQ/>/Z�X�MRl�L � /6 � .t5 t4'.S <br /> �- Describe the source of information: <br /> cctcNi, &6NFAAL KnJL) vJLt'OlrF o F A2�f1 Acres QcCo2DS <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ ] NOX <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well (t <br /> Irrigation Well ft. <br /> Monitoring Well M <br /> Other ft. <br /> 14. Will the tnnk(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ] N01K <br /> Is. 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 must acknowledge this responsibility for the billing by signature and date below. <br /> Name _ TNS 6-C TTA) PAUL l/4eM/} <br /> Mailing Address _ SZO 7-2ACV 6 L J n / Tiz tC / 6A �y 5376 <br /> Day Phone Number <br /> f'!///liln�� <br /> Signature Date <br /> Page 6 <br />