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12. What is the depth to groundwater? J i4t" <br />Describe the source of Information: <br />S,s C- <br />6 . 0.1) <br />13. Are there any water wells on this parcel or adjacent properties? YES [I NOW <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />It. <br />Private Well <br />R <br />Irrigation Well <br />IL <br />Monitoring Well <br />ft. <br />Ocher <br />It. <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES601 I <br />15. Indicate the responsible party to be b17ed for additional PHS -EH] staff time expended beyond 3 hour minimum permit payment <br />per tank. If the party designated below is different than the permit applicant, e.g. property owner, the party must acknowledge <br />this responsibility for the billing by signature and date below. <br />Name AMM67FS <br />Malllng Address 32o I � l`lC fj t/i`�tt� , 57DCA7Dn3 -. �4 9SZoS <br />Day Phone Number) Zt� ) ���-7S3Z <br />Signature Title I Da <br />EH 23 046 (Revised 10/19/98) Page 6 <br />