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12. What is the depth to groundwater? 'r <br /> Describe the source of information: <br /> -IQkQt;t.t�11 VU P�L-4 r- v2 <br /> 13. Are there any water wells on this parcel or adjacent properties? v K7t4 YES [ j NO [] <br /> I� <br /> F i <br /> TYP-E OF W- DISTANCE TO TANSS(b ' <br /> PubGc' 'eil ft. <br /> _ PHN-ate Well <br /> Irrigation Well ft. <br /> I Monitoring Well ft <br /> a <br /> Other ft <br /> F <br /> I4. Will the tank(s) pending closure be replaced with an aboveground <br /> or underground s or-age tank( <br /> Ia. Indicate the responsible pard' to be billed for additional PIIS-EI3D staff time expended beyond 3 hour minimum <br /> permit payment per tank. If the party designated below is different,than the the applicant, e.g. prn-tperty owner, <br /> the party must acknowledge this responsibility for the billing by signatureNand date below. <br /> i <br /> Name <br /> Mailing Address li i <br /> �L. <br /> Day Phone Number <br /> s � i <br /> II I <br /> ii <br />,! Signature ih Date <br /> I! <br />'I I <br /> c <br /> i I} <br /> Ij <br /> iL k <br /> e_ Page 6 <br />