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12. What Is the depth to groundwater? <br /> Describe the source of Information: <br /> (ArL <br /> i- <br /> 13. Are there any water wells on this parcel or adjacent properties? (,I YES [ ] NO <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well It. <br /> Irrigation Well ft. <br /> Monitoring Well ft. <br /> Other ft. <br /> H. Will the tank(s) pending closure be replaced with an aboveground or underground storage lank(s)? YES[ ] NOVI <br /> 15. Indicate the responsible party to be billed for additional PIIS-EIII) 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 signnlure and dale below. <br /> Name Aa ElIt(,01 �tL'fAtck( —,j7V7C- I (�} ? <br /> Mailing Address rU� C�t// � /)� rc�C y / M <br /> i Ve — / � ((1� ero\ <br /> Day Phone Number <br /> ✓y ��-�' - 73 <br /> Slg ore <br /> Date <br /> Page 6 <br />