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12. What is the depth to groundwater? <br />the source of information: <br />'14 Sall, _ 5"P, CGGli c <br />13. Are there any water wells on this parcel or adjacent properties? YES [ j NO [ j <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft. <br />Private Well <br />R <br />Irrigation Well <br />R <br />Monitoring Well <br />ft. <br />Other <br />R <br />14. Will the tank(s) pending closure be replaced with an abovegmand or underground storage tank(s)? YES[ ] NO[ j <br />15. Indicate the responsible party to be billed for additional PHS-EED 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 /C� L-SAFG L — A—i <br />Mailing Address py BOX , <br />/Sd3r., <br />6 <br />Day Phone Number t16/ �%7.;)�- — 't-41 <br />9 JOLIJ'tip ,;/// YO/400 <br />Signature Date <br />Page 6 <br />