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12. What is the depth to groundwater? <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES 1 NO l•Y <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Weil ft. <br /> Private Weil ft- <br /> Irrigation Well it. <br /> Monitoring Well ft. <br /> Other rL <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)?YES[]NO[ <br /> 15. indicate the responsible party to be billed for additional PUS-EHD staff time expended beyond 3 hour minimum permit payment <br /> per tank. If the party designated below is different than the permit appDcanL e.g.property owner,the party must acknowledge <br /> this responsibility for the billing by signature and date below. <br /> Name <br /> —7 . <br /> Malllng Address 3l /`it f .L� - �� <br /> Day Phone Numbers L�f� � "7 <br /> i e Title Date <br /> EH 23 046 (Revised 10119198) Page 6 <br />