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12. What is the depth to groundwater? 4 s <br /> Describe the source of information: <br /> Sti-6 s <br /> 13. Are there any water wells on this parcel or adjacent properties? YES pcJ NO [ [ <br /> TYPE OF WELLS DISTANCE TO TANI{S(S) <br /> Public Well ft. <br /> Private Well ft. <br /> Irrigation Well ft. <br /> Monitoring Well [ S ft. <br /> Other ft. <br /> 14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES)q NO[ J <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 +tea-�1: IL, 19t.L7�(e\,C USA PZTrn1eA A.. (-cTLP. <br /> Mailing Address 2 b ( - c)2 S J eD M,n� A L.a• ct 1 7 (c 6 <br /> Day Phone Number (Q O ) b 2.Z— '3�{'L.t( e�.r. 18 <br /> Signature Title Date —r <br /> EH 23 046 (Revised 9/11/96) Page 6 <br />