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12. What is the depth to groundwater?gAp ! &4 t <br />Describe the source of information: - L <br />13. Are there any water wells on this parcel or adjacent properties? V YES (] NO <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />It. <br />Private Well <br />It. <br />Irrigation Well <br />tL <br />Monitoring Well <br />It <br />Other <br />tt <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ] NOI ] <br />15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond 3 hour minimum permit payment <br />per tank. If the party designated below Is different than the permit applicant, e.g. property owner, the party must acknowledge <br />this responsibility for the billing by signature and date below. <br />Name �SM�7q' � CIO L `�I, c' <br />Mailing Address 1 C. S �/ 1 �1 ^ S � ` (� A J 35 <br />Day Phone Number I '? t ) 5 Z l- � 4 S3 <br />� \D' C)o <br />Signature Title Date <br />EH 23 046 (Revised 10/19/98) - Page 6 <br />