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4 <br /> 12. What Is the depth to groundwater? `1 AekMn6J/V <br /> Describe the source of Information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES )] NO)k <br /> TM OF WEDS DISTANCE TO TANKS(S) <br /> Public Well it <br /> Private Well it <br /> Irrigation Well tt <br /> Monitoring Well ft <br /> Other it <br /> 14. Will the tanks)pending closure be replaced with an aboveground or underground storage tank(s)?YES[[N <br /> 15. Indicate the responsible party to be billed for additional PHS-ERD staff time expended beyond 3 hoar 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 <br /> Halling Address <br /> Oay Phone Number( 8 DS 1 4 9 D'fo2� <br /> g16P / <br /> tura Title Date <br /> EH 23 Glu(Reviscu Dai i3i99) Pagc 6 <br />