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12. What is the depth to groundwater* <br /> 2-7 —>o FT <br /> Describe the source of information: <br /> ptyflFT4f �7 MoN Tc:C \��, wF+-t— <br /> 13. Are there any water wells on this parcel or adjacent properties? YES NO [ ] <br /> TYPE OF WEUS DISPANCE TO TANKS(S) <br /> Public Well it. <br /> Private Well N) /NZ- ft <br /> Irrigation Well it. <br /> Monitoring Well ft <br /> Other M <br /> 14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ] N(] , <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 owner, <br /> the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name� L <br /> e it ATisL <br /> Mailing Address <br /> Day Phone Number <br /> Signature Date <br /> Page 6 <br />