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12, What is he depth to groundwater? <br /> 1 <br /> Describe the source of information: e �� <br /> 1 <br /> 13. Are there any water wells on this parcel or adjacent properties? YES ] NO <br /> 1 <br /> TYPE OF VVE S [DLS7TA�NCETQ T�1NS.S(S) <br /> Public Well PPA �• <br /> Private Well s\JIpr ft. <br /> irrigationWell IL)/4r ft. <br /> 1 Monitoring Well /4/ ,� ft. <br /> Other ft. <br /> 14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES ] NO[l.]' <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 billing by signature and date below. ` <br /> 1 a 1 <br /> Name 3J1.) 0J;,J. T <br /> Mailing Address ! i c ,f7 (� <br /> 1 Day Phone Number <br /> f <br /> ror- Ae-725NL- = l3 ��y <br /> ' Sign re Date <br /> 1 <br /> Page G <br /> 1 <br />