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U. What is the depth to groundwater? <br /> t1t1K►�4bu:r� <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ ] NO [ ] <br /> TYPE OF WELI S DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well ft. <br /> Irrigation Well ft. <br /> Monitoring Well ft. <br /> Other ft. <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 PHS-EHD 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 signature and date below. <br /> Name ---r—Ay h6 <br /> Mailing Address T—�>L, 3014 3/�! SToekron[ g52-C l <br /> Day Phone Number ZO <br /> — S l - `l— <br /> Signatu / Date <br /> • <br /> Page 6 <br />