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F12. What is the depth to groundwater? <br /> Describe the source of information: �y <br /> 13. Are there any water wells on this parcel or adjacent properties? YES O'NO[] <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well <br /> Private Well -ft.. . <br /> Irrigation Well ft. <br /> Monitoring Well <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 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 d <br /> owner,the party must acknowledge this.responsibility for the billing by signature and date below. <br /> Name ` X <br /> Mailing Address rz,l Q V-c:cflc.-- <br /> Day Phone Number( ZO C1 ) X1'37—-7 5/41 <br /> A- W61(4 <br /> J*aiftCre Title Date <br /> Elf 23 046 (Revised 07/31/08) 6 <br />