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0 <br />12. What is the depth to groundwater? <br />Describe the source of information: <br />0 <br />13. Are there any water wells on this parcel or adjacent properties? YES [I NO[ ] <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft. <br />Private Well <br />ft. <br />Irri ation Well <br />ft. <br />Monftorin Well <br />ft. <br />Other <br />ft. <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? <br />YES[ ) NO[ 1 <br />15. Indicate the responsible party to be billed for additional EHD staff time expended beyond 3 hour <br />minimum permit payment per tank. If the party designated below is different than the permit <br />applicant, e.g. property owner, the party must acknowledge this responsibility for the billing by <br />signature and date below. <br />Name <br />Mailing Address <br />Day Phone Number <br />Signature Title Date <br />EH 23 046 (Revised 11/21/06) <br />