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12. What is the depth to groundwater? & © FT— EELDW 5 U <br />Describe the source of information: <br />MOM rt recti w ties 012- <br />g�,-C SCF .-Ml <br />13. Are there any water wells on this parcel or adjacent properties? YES 11 NO K <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft. <br />Private Well <br />ft. <br />Irrigation Well <br />�J /A <br />ft. <br />Monitoring Well <br />ft. <br />Other <br />ft_ _ <br />14. Will the tanks) pending closure be replaced with an aboveground or underground storage tanlgsy? YES[ 1 NO[ 1 <br />15. indicate the responsible party to be billed, for additional PDS-EHD 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 LA`1 '-O'er fba-D A)wi L--? - <br />Mailing Address 77-6 DkQ O LLSU O <br />Day Phone Number ( �'-74 --7 52- 2 -- <br />Signature � � tie to &/ OP" , <br />EH 23 046 (Revised 10/19/98) Page 6 <br />