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what is the depth to groundwater? <br />9O- 66' <br />Describe the source of informatinn- <br />13. Are there any water wells on this parcel or adjacent properties? <br />TYPE OF WELIS <br />Public Well <br />Private Well <br />Irrigation well <br />Monitoring Well <br />Other <br />MSTANCE TO TA&SS(S) <br />fL <br />M <br />R <br />R <br />rL <br />YES [ I 'No 0 <br />14. will the tanks) pending closure be replaced with an aboveground or underground storage tank(s)? YF VOA <br />15• Indicate the responsible party to be billed for additional PHS.EaD staff time expended beyond 3 hour minimum <br />permit payment ner tank If the party designated below is different than the pe e.�. proper;l winner, <br />the party must acla owledge this res ponsibilitttit appli`nty for the billing by signature and date below. <br />\Name!%d/GyS l'�7 , dr ID . <br />Mailing Address <br />arJ-eY'hor oc,o� <br />Day Phone Number( ( 6 ) 66 7 _ 74!�Z� <br />Signature <br />Page 6 <br />Date <br />