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v <br /> 12. What is the depth to groundwater? UK <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ [ NO <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well ft. <br /> Irrigation Well ft. <br /> Monitoring Well ft. <br /> Other ft. <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-EHD 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 <br /> owner, the party must acknowledge` this responsibility for the billing by signature and date below. <br /> Name //1266-244 OVZF/ZE� _l�L°�,�flbL � - <br /> Mailing Address �C��� &)- c! ' j,or) / 2�Q r: TZ0e/K7�!5/J c� A <br /> Day Phone Number (r,2061Y . 1 <br /> GGdC. If ze <br /> Si rc Title e <br /> EH 23 046 (Revised 9/11/96) Page 6 <br />