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I?- What Is the depth to gronndwater7 <br />Describe the source of information: <br />13. Are there any water wens on this parcel or adjacent properties? YES ( j NO,yf <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />TL <br />Private Well <br />rL <br />Irrigation Well <br />% <br />rL <br />Monitoring Well <br />ft. <br />Other <br />ft. <br />14. Will the tanks) pending closure be replaced with an aboveground or underground storage tanlgs)? YES ) N9e <br />15. Indicate the responsible party to be billed for additional PHS-EED staff time expended beyond 3 hour minlmnm permit payment <br />per tank 11 the party designated below Is different than the permit appDcant, e.g. property owner, the party must aclmowledge <br />this responsibility for the billing by signature and date below. <br />Mailing Address_/�(�� <br />Day Phone Number <br />z <br />Signature Title Date - <br />S✓ U (11i <br />EH 23 046 (Revised 10/19/98) Page 6 <br />