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r F � <br /> 12. What is the depth to groundwater? . 16 sect b S T? <br /> Describe Jthe source of information: <br /> 4An� � ti <br /> s <br /> A�.S !� 4 r gee.t 'Ih, Q72_a00?- <br /> 13. <br /> ooZ13. Are there any water wells on this parcel or adjacent properties? YESIKNO[] <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Wall ft <br /> Private Well ft <br /> Irrigation Well ft. on S;+e ` <br /> Monitoring Well ft. <br /> Other ft. <br /> H. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)?YES[]N0� <br /> 15. Indicate the responsible party to be biked for additional PHS-13111)staff time expended beyond 3 hour minimum permit payment <br /> per tank. If the party designated below is different than the permit appllcant,e.g.property owner,the party must acknowledge <br /> this responsibility for the billing by signature and date below. <br /> Name— Ca r V eY2,+er CO <br /> Ma.WngAddress_ 100 Sr, ar�C. Letihme SCA- 9533C^ <br /> Day Phone Number[PO 61 ) ! Z 600 <br /> V12 -f/0-9 <br /> Signature Title Date <br /> 1 - <br /> i <br /> i <br /> FH 23 046(Revised 08113199) Page 6 <br />