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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 TANICS(S) <br /> Public Well ft. <br /> Private Well fL <br /> Irrigation Well ft. <br /> Monitoring Well fL <br /> Other fL <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 parry 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 The City of Lodi/ Public Works Dept. <br /> Mailing Address P.O. Box 3006, Lodi, CA 95241-1910 <br /> Day Phone Number ( 209 333-6800 ext. 593 <br /> CA- <br /> Title Dile <br /> EH 23 046 (Revised 9/11/96) Page 6 <br />