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12. What is the depth to groundwater?� 20 <br /> Describe the sou a of information: <br /> I�ih, �tJL.v 1 >" <br /> 13. Are there any water wells on this parcel or adjacent properties? YES kr� NO [ ] <br /> TYPE OF WEI.IS DISTANCE TO TANILS(S) <br /> Public Well ft. <br /> Private Well �(lt <br /> Irrigation Well it <br /> Monitoring Well ft. <br /> Other M <br /> 14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ] NO[ ] <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 party designated below is different than the permit applicant, e.g. property owner, <br /> the party must acknowlede thisresponsibilityrresponsibility for the billing by signature and date below. <br /> Name -5144,,,,L) <br /> l�'t/ \ ✓� �� , / 7-5-378 <br /> Q <br /> Mailing Address ��} Z0 x [ /I / "C wl C4- [q 5-3 7CJ <br /> Day Phone Number 2C/T J 5- <br /> -- -h - <br /> �gj� ( CZ <br /> Signat Date <br /> Page 6 <br />