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12. What is the depth to groundwater? �0 t�.5 P e7L L 1 N 4A. o� �71 w <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ ] NO [c}--� <br /> TYPE OF WELLS 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 ( ] <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 <br /> owner, theparty must acknowledge <br /> this responsibility for the billing by signature and date below. <br /> Name <br /> Mailing Address 2(�( _ �- ZST. PO,�D.,A Co 4 ( 7(0 6 <br /> Day Phone Number c 9 0 , 622-3 Lf Z N K / 8 <br /> Signature Title Date <br /> EH 23 046 (Revised 9/11/96) Page 6 <br />