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12. What is the depth to groundwater- <br /> � S 0 - 3 C' �(+ C'9'. 8-o—q 0 <br /> Dekcribe the so bf��- Ilmatjon:r <br /> F6P�D C�TV-o(_ + W P17SP— Q'd$E1—F—V KJU tj <br /> , <br /> Nt&A-L- /-0&t t.1 b w*-rXP- P e,,2p r4- (!5 4�7c- !n&",Qrj <br /> 13. Are there any water wells on this parcel or adjacent properties? YES NO [ <br /> OFWELIS DISTANCE To TANKS(S) <br /> Public Well N/ft ft. <br /> Private Well ft. <br /> Irrigation Well <br /> Monitoring Well ft. <br /> Other ft. <br /> 14. Will the tank(s) pending closure be replaced with an abavegrouDd or underground storage tank(s)? YES I I NOV] <br /> 15. Indicate the responsible parry to be billed for additional PHS-EBI) 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 R'%V-F Kc <br /> Mailing Addrvss ? 0. --go)( do <br /> Day Phone Number C_0� ) <br /> 7 114 LC-,l <br /> Signature Date <br /> Page 6 <br />