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F12What is the depth to groundwater?escribe the source of information: y <br /> 13. Are there any water wells on this parcel or adjacent properties? - YES d NO[] <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well fL <br /> ' Irrigation Well ft. <br /> Monitoring Well "Lo 0 ft. <br /> Other ft. <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)? YES[]NO[q--� <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 <br /> owner,the party must acknowledge this responsibility for the billing by signature and date below. <br /> t <br /> Name bJ4:L r,( k 2S= qU <br /> ' Mailing Address l v-cx SF <br /> ' Day Phone Number( ZO 01 <br /> afore �,� Title Date <br /> 1 <br /> EH 23 046 (Revised 07/31/08) <br />