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12. What is the depth to groundwater? ] L t <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [] NO[] <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well ft. <br /> Irrigation Well ft. <br /> Monitoring Well 200 ft. W 141S 1C <br /> Other ft. <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)? YES[]NOKII� <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 /> Name Gt'M [dFSNT-0Cl1 —tht.n 60 U�O?Llne V' <br /> Mailing Address DovaL q (' 7i rC\4;\ oov SC tee, C p , 4 S ZoL <br /> Day Phone Number Z 0 9,7 -l 54-1 <br /> 09 <br /> na r-Siie1�A1Title <br /> Date <br /> EH 23 046 (Revised 07/31/08) 6 <br />