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12. What is the depth to groundwater^. <br />Describe the source of information: <br />u <br />13. Are there any water wells on this parcel or adjacent properties? YES > NO ( ] <br />TYPE OF WELLS <br />I DmrANCE TO TANSs(b7 <br />Public Well <br />It <br />Private Well <br />Z ft - <br />Irrigation Well <br />ft. <br />Monitoring Well <br />ft <br />Other <br />ft <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ] NOW <br />15. Indicate the responsible party to be billed for additional PISS-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 owner, <br />the party must acknowledge this responsibility for the bflling by signature and date below. <br />Name r'Ipq?–q '+ Su6A--1y 'B(.�7 <br />Mailing Address -/5-)57-/5-)57h rpME-rc <br />2 l'M t" -T <br />Day Phone Number ( �2Ccl ) /3) 0 T T SI <br />X <br />Signature <br />Page 6 <br />Date <br />