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12. What is the depth to groundwater? <br /> Describe the source of information: ��� <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ I NO <br /> TYPE OF WELLS I 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)? YES71 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, thhe� party must acknowledge this responsibility for the billing by signature and date bellow. (� <br /> Name l i�� o� =1(1QCS � W (Q�Ske% �VC1��11 k� ctfYLr2" t'tQQ <br /> Mailing Address ���1(�� AA-n (`,-1 <br /> Day Phone Number O( Del 1 y <br /> gnature Title Date <br /> EH 23 046 (Revised 9/11196) Page 6 <br />