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r= z. <br /> 12. What Is the depth to groundwater? 7S. <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES N NO f <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> i <br /> Private Well ' l 5 C ft. <br /> Irrigation Well ft. <br /> Monitoring Well ft. <br /> Other ft. <br /> 14. Win the tank(s)pending closure be replaced with an aboveground hr underground storage tank(s)?YESI j NO[I <br /> is. Indicate the responsible party to be baled for additional PHS•ERD staff time expended beyond 3 hour minlmum permit payment <br /> per tank. It the party designated below Is different than the permit applicant,e.g.property owner,the party must acknowledge <br /> Us responsibility <br /> `for the billing by signature and date below. <br /> Name A 1 V-IA-JLl y , r+ ,� <br /> Mailing Address L{ 3 SJR In,-AV (I>to S VV-* IG.[a r l b CAL <br /> lr ro t.. LIA <br /> Day Phone Number( ZOCA <br /> - <br /> 3lgnatar Title Date <br /> EH 23 046(Revised 08/13/99) Page 6 <br />