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12. What is the depth to groundwater? UPJ \!,n) o�A\ <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 ft. <br /> Other ft. <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)?YES(]NO[ <br /> 15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond 3 hour minimum permit payment <br /> per tank. If the party designated below is different than the permit applicant,e.g.property owner,the party must acknowledge <br /> this responsibility for the billing by signature and date below. <br /> Name—� 1 rti -E' A C. E - 7 A\ 7 R 1`-L(�C\ [�i G- C A M L <br /> Mailing Address SLP O 1E, <br /> Day Phone Number( 1(o ) <br /> r <br /> Signature Tit! Date <br /> EH 23 046 (Revised 10/19/98) Page 6 <br />