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12. <br />13. <br />v <br />:ghat is the depth to groundwater? Unknown <br />Describe the source of information <br />:ire there any water wells an this parcel or adjacent properties? <br />TYPE OF WELLS I <br />DISTANCE TO TANBS(S) <br />P <br />al! <br />YES [) NON <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 -EM staff time expended beyond 3 hour minimum permit payment <br />per tank. If the parry 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 Diesel Performance, Inc. <br />Mailing Address P. 0. Box 8387, Stockton CA 95208-0387 <br />(209) 1 946-0233 <br />Title Date <br />EH1-3046 (Revised 08/13/99) Page 6 <br />