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12. What is the depth to groundwater' <br /> Describe the source of information_ . n <br /> "4'k <br /> y�.7� � <� .kms GLtY-✓ <br /> 13. Are there any water wells on this parcel or adjacent properties YES NO i I <br /> TYPE OF WELLS DLSTAIYCE TO TAWS(S) <br /> Public Well ft <br /> i Private Well pZOa R <br /> Irrigation Well It. <br /> Monitoring Well R. <br /> Otber fL <br /> L�,WozntJ ,99 <br /> 14. Will the tank(s) pending closure be replaced with an abovego nd or underground storage tank(s)zYEsl I <br /> 15. 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 parry designated below is different than the permit appiictot, uP, property <br /> owner, the party must acknowledge this responsibility for the billing by signature and date blow. <br /> Name cAg(-A <br /> Mailing Address T 7� aL E� �l f �'� CA 9J'f 7" <br /> Day Phone Number ( X09 } �.�fo 060 <br /> 14 <br /> Signature Title Date <br /> S!23 046 (Revised 9111196? Page 5 <br />