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12. What is the depth to groundwater? Afffi?)s i <br /> Describe the source of Information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES (j NOV <br /> F'�TY�PEWELLS DISTANCE TO TANKS(S) <br /> ell ft, <br /> Private Well tt- <br /> Irrlgation Well ft. <br /> Monitoring Well ft, <br /> Other ft, <br /> lvi S ce-In 5 / <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)?YES(leo ✓ <br /> 15. Indicate the responsible party to be billed for additional PHS-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 <br /> _by signature and date below. <br /> Name ,.11n�VI,ttM,, l t d �ci � <br /> Mailing Address bU flpmk61 <br /> Day Phone Number( /20 <br /> Sl alar �Irrt�� UZ <br /> Title Date <br /> EH 23 046 (Revised 08/13/99) Page 6 <br />