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0 <br /> 12. What is the depth to groundwater? rrII <br /> 7� <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES NO [ J <br /> TYPE OF WELLS DIb'rANCE'r0 TANES(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)? YES[ J NO[ J <br /> 15. Indicate the responsible party to be billed for additional PHS-EIID staff time expended beyond 3 hour minimum <br /> permit payment per tank If the party designated below is dilrerent 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 Annie- Lin <br /> Mailing Address P n 661 <br /> 9^ <br /> Day Phone Number ( ) OCI, t(l d <br /> Signature Date <br /> Page 6 <br />